Spring 1994

Vol. XXXl No. 1

JAYNE M. STANDLEY The Florida State University





JANET P. GALLOWAY Hilton Head Island



BRUCE M. SAPERSTON Utah State University JOSEPH SCARTELLI Radford University DAVID S. SMITH University of Georgia ALAN L. SOLOMON University of Evansville MYRA J. STAUM Willamette University LOUISE STEELE Cleveland Music School Settlement MICHAEL THAUT Colorado State University BARBARA L. WHEELER Montclair State College DAVID WOLFE University of the Pacific

ALICIA A. CLAIR University of Kansas ALICE-ANN DARROW University of Kansas ANTHONY DECUIR Loyola University AMELIAG, FURMAN Minneapolis Public Schools KATE GFELLER University of Iowa JUDITH JELLISON University of Texas CLIFFORD K. MADSEN The Florida Stats University CHERYL D. MARANTO Temple University CAROL A. PRICKETT University of Alabama

This paper

meets the requirements of




of Paper).

journal of

music therapy
Spring 1994 2 Psychiatric Music Therapy Assessment and Treatment in Clinical Training Facilities with Adults, Adolescents, and Children The Effect of Improvisational Music Therapy on the Communicative Behaviors of Autistic Children Effects of Performing Conditions on Music Performance Anxiety and Performance Quality Call For Papers Vol. XXXI No. 1 ARTICLES Michael D. Cassity Julia E. Cassity

Cindy Lu Edgerton


Melissa Brotons ,



Psychiatric Music Therapy Assessment and Treatment in Clinical Training Facilities with Adults, Adolescents, and Children’
Michael D. Cassity Julia E. Cassity Southwestern Oklahoma State University New Horizons Community Mental Health Center This study sought to define and measure the common body of knowledge relating to psychiatric music therapy assessment and treatment as practiced in NAMT-approved clinical training facilities. Specifically, the study reported areas of nonmusic and music behavior assessed most frequently, specific component behavior and music behavior most commonly assessed within each ares, the type of music conditions employed most commonly to assess such component behavior, and the developmental level of the patients to whom the assessments were given. Developmental level was observed as a function of the degree of illness and chronological age of the patient, and nonmusic component behaviors were reported es specific problem-oriented behaviors. In addition, areas clinical training directors assessed most frequently when administering activity assessments were determined. The results indicated the existence of an extensive and significant relating to psychiatric music common body of knowledge therapy assessment and treatment.

The authors wish to express appreciation to the Oklahoma State Regents for Higher Education, Edward Daniel Dill, Ph.D. and Charles W. Chapman, Ph.D. for funding this study. Appreciation also is expressed to the music therapy clinical training directors who made this study possible, and to Jennifer Nail and Ann Kiser for clerical assistance. This study is dedicated to Professor Emeritus Charles Braswell for his 36 years of service to the music therapy profession at Loyola University, New Orleans. Inquires regarding this article should be addressed to Dr. Michael D. Cassity, Department of Music. Southwestern Oklahoma State University, Weatherford, OK 73096-3098.

Spring. According to the American Association on Mental Deficiency (Grossman. when applicable.Vol. therefore. Similar areas of nonmusic assessment are targeted with developmentally disabled children (including psychiatric patients in infancy. 1. Assessment and programming appropriate to developmental level also is emphasized in related professions. Cohen and Gericke (1972) define assessment as the process of gathering information about a patient’s strengths and weaknesses for the purpose of program planning. require the assessment to be appropriate for the patient’s level of functioning. 1963). The NAMT Standards for adult psychiatry. and states that deficits in these adaptive behaviors should be the criteria for determining programming needs. social age (Doll. With mentally retarded . in addition to targeting areas for nonmusic assessment.XXXI. Degree of illness is rated in the Diagnostic and Statistical Manual Of Mental Disorders III-R (DSM-III-R) (APA. and adolescence). The music therapy assessment. 1994 3 Assessment is considered an important part of the practice of music therapy. 1965). the appropriateness of assessment and programming for the mentally retarded is dependent upon CA and degree of retardation. should be appropriate in terms of the level of functioning and the chronological age (CA) of the patient. childhood. and perceptual age (Frostig. The Standards for children also state that. The National Association For Music Therapy (NAMT) Standards Of Clinical Practice (1993) specify assessment as the first task of music therapists following patient referral and acceptance. 1960). Other types of developmental indexes used by related professionals include mental age (Terman & Merrill. The AAMD also provides examples of the highest level of adaptive behavior that may be expected given CA and level of mental retardation. The AAMD has specified adaptive behaviors which are appropriate for specific CA levels. 1977). 1987) using the Global Assessment of Functioning Scale (GAF Scale). level of functioning or developmental level within these areas shall be reflected in the music therapy assessment. The American Psychiatric Association (APA) also provides for diagnosis according to CA levels and degree or severity of illness. No. The assessment mandates of the NAMT Standards also are supported by music therapy research. childhood. and adulthood. adolescence. CA levels in the DSM-III-R include infancy.

was the primary purpose of the present study. Although the above studies have produced specific information about music therapy assessment. little is known concerning the frequency with which music therapists actually assesssuch areas. In addition. Identification of the above information.4 Journal of Music Therapy and developmentally disabled children in general. Such information was considered essential to defining adequately the common body of knowledge relating to psychiatric music therapy. there has been a paucity of similar empirical research examining assessment practices in psychiatric music therapy. differ depending on the CA level of the patient. music therapists use music extensively to assessboth nonmusic and music behavior (Davis. Nonmusic component behaviors were reported as specific problem-oriented behaviors. music therapy assessment practices with the mentally retarded. According to Cassity. 1986). . Decuir. 1982). the specific nonmusic and music component behaviors music therapists most commonly assess within each area. CA. diagnosis. Developmental level was observed as a function of the degree of illness and CA of the patient. Other types of developmental indexes utilized in the music therapy assessment are cognitive development (Jones. the type of music conditions they employ most commonly to assess such behavior. 1981) and developmental norms or milestones (Michel & Rohrbacher. or the developmental level of the patients to whom the assessmentsare given. 1986. Lathom. and attitude (Braswell. Cassity (1985) surveyed the practice of music therapy with trainable mentally retarded children according to the above AAMD CA levels. Rider. 1992. little is known concerning areas music therapists address most frequently when administering activity assessments. therefore. Two notable exceptions were studies which defined music therapy assessment practices with domestic violence patients according to CA level and sex (Cassity & Theobold. is an important measure of the validity and appropriateness of music therapy assessment and intervention. and a music/activity therapy intake assessment designed to collect data according to CA. including the types of behavior assessed and the music conditions used to assess the behavior. & Sutton. Although the NAMT Standards indicate appropriate areas for assessment. Humphrey. 1990). Jacobs. 1980). Brooks. therefore.

Clinical training facilities which had been in existence for less than 1 year were excluded from the study. the questionnaire for adolescents contained 42 areas. 1994 Method Subjects An initial letter of inquiry and a participation form were sent to all music therapists listed by the NAMT Directory of Clinical Training Facilities as clinical training directors (CTDs) at psychiatric facilities. adolescence. CTDs who indicated a willingness to participate in the study were subsequently sent a questionnaire designed to survey their assessment practices with the patients for whom they had indicated greatest expertise and preference.XXX/. Spring. Procedure Separate questionnaires were designed to survey assessment techniques with adult males. adult female. The survey population was restricted to clinical training directors (CTDs) partially because CTDs as a group probably are among the most (if not the most) experienced clinicians in the music therapy profession.Vol. These areas had been extracted from a thorough review of . It was assumed that CTDs could provide the most accurate and representative information concerning assessment practices in clinical training facilities. The questionnaire for adults contained 23 areas. adolescents. and the questionnaire for children contained 20 areas of nonmusic behavior recommended for assessment in the music therapy literature. No. If the CTDs checked adulthood. and children. Another reason for limiting the survey population to CTDs was to obtain information which would assist educators in preparing preservice music therapists for clinical training. 1990). and/or infancy. or both. Assessment in infancy was not surveyed because an insufficient number of CTDs indicated they worked with such patients. adult females. If the CTDs indicated a willingness to participate in the study. childhood. they were asked to indicate the type of patient(s) they preferred and were most qualified to assess by checking the CA level(s) of adulthood. Limitations have been associated with previous studies which have surveyed music therapy skills and practices without controlling for limited experience among the respondents (Jensen & McKinney. 1. they were asked to specify adult male.

and activity therapy assessment were each listed in alphabetical order.6 Journal of Music Therapy literature relating to psychiatric music therapy assessment (Adleman. 1983. Michel & Rohrbacher. CTDs were asked to list the five areas they assessed and treated most frequently. 1987). CTDs were also requested to write in any additional areas they assessed that were not listed. music behavior. and of developmental checklists. 1976. Wood. Next to each problem behavior. 1985: Cassity & Theobold. for each of the five assessment areas they had just listed. 1980. Jacobs. 1972. Cohen & Gericke. the questionnaire contained an example of a completed questionnaire item for nonmusic behavior and one for music behavior to guide the CTDs in furnishing the desired information. Areas of music behavior were derived from a review of music activities used in psychiatric music therapy (Carroccio & Quattlebaum. Gigliotti. Ficken. they also were requested to list two specific music conditions they used to assess and/or treat the problem. 1974). & Sutton. and music curricula for exceptional children (Graham & Beer. The areas of nonmusic. From the list of 23 assessment areas. Noland. Wood et al. Freed. Swan. The procedure for constructing the section of the questionnaires relating to music assessment was the same as above with the exception that music areas were included. music. CTDs were requested to choose 10 of the 42 areas. then rank order the 10 areas by assigning a “1” to the area they assessed most frequently and a “10” to the area they would assessleast frequently. 1987. Finally. 1969. The two questionnaires designed for children were for children in the CA level of childhood and adolescence. 1989). 1976. Rubin. Brooks.. 1993. . and that they felt were most important in music therapy assessment and treatment. Cassity. 1986. 1990. Decuir. Humphrey. CTDs were next requested to list. with the order of listing rotated among the questionnaires. 1974). & Samet. Areas assessed most frequently during activity therapy assessment were determined by listing in the questionnaire 42 areas of activity therapy assessment suggested in the music therapy literature (Braswell. NAMT. NAMT. Purvis. 1982). 1980. 1976. and therefore reflected the CA levels recommended in the DSMIII-R (APA. Graham. two specific problem (nonmusic) behaviors they assessand treat most often. 1989. Lathom.

in generalizing the following results to psychodynamic settings. Approximately 73% of . four were eclectic and one was of psychodynamic therapeutic philosophy. 1994 7 Following the construction of the questionnaire.. Caution must be exercised. Typical reasons for nonparticipation were there had been a recent change of clinical training directors. Spring. As for the number of years of full-time experience in adult psychiatric music therapy. The highest degree attained by CTDs varied depending on the CA of patient with whom they worked. and was employed as a full-time clinical training director. Respondent Characteristics The first part of the questionnaire dealt with respondent characteristics. Although all had a bachelor’s degree. 61%. The typical CTD had graduated from an NAMT-approved music therapy program 9 years prior to the study. In contrast. indicated the questionnaire did not relate to her practice of music therapy. 46% of the CTDs who worked with adolescents and 53% of the CTDs who worked with children had a master’s degree. Results Of the 100 psychiatric clinical training facilities identified. The panel did not participate in the study other than to judge the questionnaire. adolescents. The psychodynamic music therapist.Vol. and/or the CTD did not have time to participate in the study.XXX. Of the five music therapists. adult male. a panel of five registered music therapists employed in NAMT-approved clinical training facilities assessed the clarity of the questionnaire items. 41% indicated more than 9 years. 74%. most psychiatric CTDs were females between the ages of 30 and 39. 65 agreed to participate in the study. and adult female. 31% indicated 6-8 years and 20% indicated 3-5 years. The percentages of CTDs returning the questionnaires for each CA level of patient were children. however. only 19% of the CTDs working with adults had a master‘s degree. No. and the success of the questionnaire in surveying the topic (assessment techniques) it was constructed to survey. 73%. therefore. 1. 67%. the ease with which responses could be provided for the items. The four eclectic music therapists agreed the questionnaire was appropriate for the purposes for which it was designed. As may be expected.

Music therapy as activity therapy was used approximately 62% of the time with adolescents and children. music therapy as insight therapy with reeducative goals. CTDs do. The type of music therapy used by CTDs varied depending on the CA of the patient with whom they worked. It appears that most CTDs do not administer standardized tests employed by other professionals. However. and none assessed music behavior only. 83% of all CTDs indicated they assess both nonmusic and music behavior. music therapy as insight therapy with reeducative goals was employed 62% of the time with adults and 37% of the time with adolescents and children. nonmusic behavior.8 Journal of Music Therapy all CTDs were employed in free-standing psychiatric facilities. or both. In contrast. 94% indicated they do not. This latter finding may seem questionable considering that reconstructive therapy most commonly is used with adults. and 51% who worked with adult patients indicated a need for a . however. 1967). the need for a standardized activity assessment increased as the CA of the patient decreased. 1958). and asking them to indicate the percentage of time they used each in their clinical training program. along with the ineffectiveness of reconstructive therapy with low-level. When asked if they administer to their patients standarded tests commonly employed by other professionals when assessing their patients. Only 17% indicated they assessed nonmusic behavior only. chronic patients (Braswell. 1983). the finding is not surprising. when one considers the low level of functioning of the typical adult patient served by music therapists (as reported in the following paragraphs). When asked whether they assess music behavior. 63% who worked with adolescents. and 37% of the time with adults. believe there is a need for certain assessment materials specifically designed for use by music therapists. and insight therapy with reconstructive goals (Wheeler. Seventy-five percent of the CTDs who worked with children. Reflective of the above finding that more activity therapy is conducted with younger patients. Data were obtained concerning type of music therapy employed by giving CTDs the definition of activity therapy (English & English. such as state or private psychiatric hospitals. Music therapy as insight therapy with reconstructive goals was used approximately 14% of the time with adolescents and only 2%)of the time with adults and children.

Vol. than they spend treating other disorders with adult males (x2 = 55. affective disorders. adjustment disorder. substance abuse. “the probability is about 95% that a rating given a patient will be within 11 points of his ‘true’ rating. anxiety disorders. Patient Characteristics CTDs spend a significantly greater mean percentage of time treating certain disorders. psychotic disorders. adolescents (x2 = 38.001). and 92% of all CTDs indicated a treatment manual of techniques.001). p < . Spitzer. and least frequently. affective disorders. adult females (x2 = 68. With adolescents. adjustment disorders. According to Endicott et al. (1976). affective disorder. and children (x2 = 51. CTDs were asked to rate the level of functioning typical of the majority of patients treated in their clinical training program using the Global Assessment of Functioning Scale (GAF) (APA. With adult females.61. substance abuse. Endicott. With children.83. and psychotic disorders. CTDs most often treat psychotic disorders. substance abuse. and Cohen (1976) have concluded the relative reliability. followed by personality disorders. from most to least frequently. are for adult male patients. adjustment disorders. The types of disorders treated. procedures. p < . 1. and practices used by psychiatric music therapists was needed. and adjustment disorder. In an effort to obtain information on the degree of illness of patients treated by CTDs. personality disorder. 1994 9 standardized activity assessment. defined as the mean rating given him by a large number of profession- . 1993). affective disorders. 79% believed a standardized music therapy assessment of nonmusic behavior was needed. 1987). XXX/. and anxiety disorder. Fleiss.001). and simplicity of the GAF suggests its usefulness in a wide variety of clinical research settings. validity. One result of the present study was the production of such a manual (Cassity & Cassity. anxiety disorders. p < . CTDs most frequently treat conduct disorders. anxiety disorder.16. substance abuse. The need for a treatment manual was clearly the greatest need indicated by CTDs. psychotic disorders.72. or diagnoses. No.001). the disorders are conduct disorder. p < . Spring. Seventy percent of all CTDs indicated a standardized test of music behavior was needed.

the level of functioning typical of the majority of patients treated in their clinical training program. The following description applies to patients with a GAF rating of 31-40. the level of functioning typical of the majority of adolescents treated in their clinical training program.10 Journal of Music Therapy als” (p.g. or mood (e. ..51. 1987. and is failing at school). and adolescents and children (x2 = 70. CTDs indicated they treat patients of certain GAF levels significantly more frequently than other levels with adults (x2 = 114. and is unable to work. flat affect and circumstantial speech. (APA.. with each interval containing a verbal descriptor of typical patient symptoms. Although 71% of all children were given GAF ratings of between 33 and 50. speech is at times illogical. such as work or school. depressed man avoids friends. (APA. child frequently beats up younger children. The GAF is arranged into nine 10-point intervals. 87% of the CTDs indicated the level of their adolescents to be between 31 and 50. using the GAF.5 and the median was 41. When asked to indicate. p < . obscure. Specifically. p < . 1987.” representing the most severe symptoms. The mean GAF rating was 36. The mean GAF rating was 40. thinking. unable to keep a job). neglects family. using the GAF. family relations. p. 767).001). CTDs were asked to indicate. is defiant at home. occasional panic attacks) OR moderate difficulty in social. or irrelevant) or major impairment in several areas. no friends. therefore approximating the typical adult treated in psychiatric music therapy clinical training programs: Some impairment in reality testing or communication (e. judgment. to “90. p.g. The GAF ranges from “1. 12) Children were given the highest GAF ratings..” representing the mildest symptoms.001). The level of functioning of the typical adolescent treated in psychiatric music therapy clinical training programs therefore would border between the above descriptor and the following for patients with a GAF of 41 to 50: Serious symptoms (e. occupational.g.. or school functioning (e.06. 12) CTDs gave somewhat higher GAF ratings to their adolescent than to their adult patients.5 with a median of 33. 70% of the CTDs indicated the level of their adult patients to be between 21 and 40.g.

adolescents (x2 = 126. A cross tabs analysis of GAF rating and highest degree obtained indicated significantly more CTDs with a master’s degree worked with adult male and female patients having GAF ratings above the median than below the median (p = . were limited to the above areas of assessment since these areas represent the bulk of music therapy assessment practices. interpersonal. With children. affective. For a comprehensive clinical manual of all areas and problems assessed/treated. and all specific music activities or conditions employed the reader is referred to Cassity and Cassity (1993).001). Interpersonal-socialization was the most frequent area assessed with adults (33%) and children (31%). and physical (including motor and receptive/expressive language) problems accounted for 82% of all problems assessed/treated by CTDs. Seventy-six percent of all adult problems and 85% of all adolescent problems assessed/treated by CTDs were either interpersonal. Spring. 1994 11 the mean GAF was 45. the frequency with which they were list- . therefore. only the most frequent patient problems within each assessment area were reported. p < . with the types of music conditions employed most frequently by CTDs to assess/treat the problems. or cognitive problems.27. Such differences were not observed for adolescents and children. Although CTDs listed 36 different adult interpersonal problems. p < . Stated differently.20. p < . behavior. The following results. where as many CTDs with master’s degrees worked with patients having below median as above median GAF ratings. The above descriptor therefore would approximate patients treated in psychiatric music therapy clinical training programs who were in the CA level of childhood.Vol. Also.XXX/. 86% of the CTDs with a master’s degree gave above median GAF ratings to their adult patients.001).006). 1. Interpersonal-sociolization. Assessment and Treatment: Nonmusic Behavior CTDs prefer to assess and treat certain areas of problems significantly more frequently than others with adults (x2 = 298. cognitive.001).79. The remaining problems with their specific music conditions were too numerous to be included in the present report.76 and the median was 45. and the second most frequent area of assessment with adolescents (31%). No. and children (x2 = 39.

the frequency with which they were reported differed significantly (x2 = 23. peer interaction and group discussion were facilitated by dividing patients into pairs. For example. Improvisation sessions were designed to elicit nonverbal and verbal group interaction.39. or depressed. Music listening activities consisted of music conditions requiring patients to work together on a cooperative task. and movement/dance (x2 = 13. not feeling comfortable when in a group.12 Journal of Music Therapy ed significantly differed (x2 = 597. p = . exhibiting isolative behavior with minimal personal interactions or no verbalization.61.53. music listening and instrumental activities significantly more often than singing. how they communicated. Types of instrumental music conditions utilized to assess/ treat withdrawn behavior were improvisation and one-to-one instruction on a music instrument. the preference for assessing/treating withdrawn behavior approached significance (Z = -1.0823). Although CTDs reported five different music conditions for assessing/treating withdrawn behavior. p < . p < . The purposes of one-to-one instrumental instruction were to establish rapport and trust.82. p < . CTDs described their withdrawn patients as seclusive.063). not initiating conversation. then asking them to select a song or recording to which they both could relate. It is interesting to note that the tendency for CTDs to assess/treat poor leisure skills among adult males more often than adult females approached significance (Z = 1. after which the group discussed issues such as what it felt like to be the leader. musical games. and whether the communication techniques needed to be changed. Of the two problems. indicating CTDs used music therapy to assess/treat certain interpersonal problems significantly more often than other interpersonal problems. The two interpersonal problems assessed/treated most frequently were withdrawn behavior and poor leisure skills. In another. For example. in order of frequency. in one music condition patients were involved in a group discussion of song lyrics.001). p = .001). CTDs chose. indicating CTDs may consider withdrawn behavior to be even more important than assessing/treating poor leisure skills.001). in one improvisation activity patients took turns conducting the improvisation. preoccupied with personal problems. and to prepare the .

excessively negative). and failure to engage in leisure activities. and other destructive defenses.00003). in the frequency with which they listed the four most frequent problems. “I like the way that sounds” to “(patient’s name) played well. and distancing others through sarcasm. instrumental activities with a focus on cooperation was the music condition of choice. Of eight interpersonal childhood problems CTDs reported assessing and treating. inappropriate use of leisure time. leading. then takes a solo while being accompanied). Music therapists used a variety of treatments. not giving or receiving positive comments. No significant differences occurred. 1. four were listed significantly more frequently than the other four (Z = -4. and imitating improvisations. The five most frequent adolescent interpersonal problems assessed/treated by CTDs were. p < .06. No. Spring. The four . however. CTDs also prefer to use music therapy to assess and treat certain interpersonal problems over others when working with children.g. in order of frequency. Performance and improvisational groups. Adolescents who demonstrated lack of awareness of self or others were described as being detached. and providing the patient with experience at supporting others by involving the patient in “supported solos” during group improvisation (e.14. were used to promote positive interaction.00003). XXX/.Vol. the patient accompanies another patient. for example. CTDs assessed and treated 10 interpersonal problems of adolescents. anger. and group improvisation in which the adolescent was given experience at playing. not interacting appropriately with peers (e..” discussing peer reactions to positive/negative statements. 1994 13 patient for ensemble participation or solo performance with the goal of increasing interpersonal interaction. No significant difference occurred.g. to redirect patient comments such as. however. Examples included making the adolescent’s cooperation in a performance group dependent upon group success. in the frequency with which these five most frequent problems were listed.. lack of awareness of self or others. p < . having poor peer relationships. Of these 10 problems. uncooperative behavior. withdrawal. five were reported significantly more often than the other five (Z = -5. Although a variety of different music conditions were listed for assessing/treating uncooperative behavior.

listening. and excessive shyness. withdrawal. such as a rhythm band. music therapy activities such as singing. Affect. p < ."). creating music.. Although a variety of music conditions were suggested. and not sharing. and demonstrated . avoiding interaction with a lack of interest in peers. Adolescents with an inability to identify/express feelings commonly replied “I don’t know” when asked how they felt. CTDs most often assessed and treated withdrawal by first using group instrumental activities. and playing instruments were made contingent upon appropriate behavior.g.40. Various types of point or token systems also were suggested for use with the music therapy activities.001). and not making constructive suggestions. not participating in groupactivities.. CTDs used music therapy to assess and treat certain adolescent affective problems significantly more frequently than other affective problems (x2 = 55. the technique suggested four times most frequently was applied behavior analysis involving the use of contingent music. Verbal interaction was fostered by encouraging the patient to engage in appropriate verbal interaction with a peer during routine interactive music activities (e. uncooperativeness. patient plays rhythm pattern on claves and the therapist/peer imitates. therapist/peer plays rhythm followed by the patient imitating). and second most frequent problem assessed with adults (22%). Children exhibiting disruptive or inappropriate behavior were described as exhibiting disruptive outbursts to attract attention. to encourage nonverbal interaction with the therapist and peers (e. these assessments were not discussed.49%). For example. Of the adolescent affective problems reported. moving. “Do you want the drum?” "Hold the autoharp while I strum. making negative comments to peers resulting in peer rejection. and manifest anger or rage towards others (25. the two assessed and treated by most CTDs were the inability to identify/express feelings (33. breaking rules. Affective problems were the most frequent type of problem assessed with adolescents (33%).14 JournalOfMusicTherapy interpersonal problems assessed and treated most frequently with children were disruptive or socially inappropriate behavior.33%). Childhood withdrawal was characterized by minimal or no verbal interaction.g. Because affective problems were among the less frequently assessed problems with children (10%).

p < . and/or volume did not match their speech content).001). frustration).011). as music listening with discussion was recommended more often than improvisation (p = . hitting walls. Although 19 different adult affective problems were reported.. and/or throwing chairs). Stated differently. and music composition. CTDs preferred to assess/treat the in- . XXXI. and conducting a “feeling card” activity in which the patient. with the inability to identify/express feeling or emotion reported significantly more often than low frustration tolerance. Such patients were reported to be overly destructive to self.30. p < . and significantly more often than music composition (p = . As with adolescents. the frequency with which the 19 affective problems were reported differed significantly (x2 = 511.. their facial expression. vocal tone. selected the card with the word that matched the feeling projected in the music (e.059). p < .54. The three music conditions CTDs recommended for assessing/treating the inability to identify/express feelings were music listening with discussion. CTDs chose to use a different type of music condition than the above when assessing/treating adolescent anger or rage.27. anger. Examples of techniques were having patients identify feelings expressed by the singer/songwriter in popular song lyrics. given a number of cards. yelling. the second most frequent affective problem (Z = -6.g. 1994 15 flat or inappropriate affect with a lack of congruity between affect and verbalization (e. 50% of the music conditions were designed to assess/ treat the inability to identify/express feeling or emotion. 1. fighting. however. improvisation. body posture.00003). The music condition recommended by a majority (54%) of CTDs was the use of instrumental improvisation as a nonverbal technique for fostering self-control and providing a constructive outlet for frustration. In contrast. Spring.Vol. there was an even greater consensus among CTDs in the assessment/treatment of the inability to identify/express feeling or emotion than there was with adolescents. CTDs used a variety of music listening with discussion techniques to assess/treat the inability to identify/express feelings..g. language. With adult patients. The frequency. No. or property (e. with which these music conditions were recommended significantly differed (x2 = 25.001). and other intense emotions. others.g.

During music listening with discussion.and long-term memory. Music listening with discussion was chosen significantly more often than instrumental improvisation. Cognitive problems were the third most frequent type of problem assessed with adults and adolescents (21%). deficit short.001). the second most frequent music condition (Z = -2. instrumental/vocal performance was used significantly more often than music listening with discussion (p = .0222). p < . p < . The song discussion was then generalized to the patient’s life situation. and disorientation were assessed and treated significantly more frequently than deficit memory. and cognitive problems tied for second position with children.021). low self-esteem was assessed significantly more often than delusions (Z = -2. the two most often assessed and treated by CTDs were low self-esteem (26.00003). the three cognitive problems CTDs as- . were deficit problem solving.001). and second most frequent problem assessed with children (17%). and denial of problems (Z = -10. and peer acceptance. Of 22 adult cognitive problems reported.006). interpretive drawing to music (p = . disorientation.004).71. physical. CTDs preferred to use certain music conditions significantly more often than others to assess/treat low self-esteem (x2 = 23. p = . With adolescents. to help the patient identify and express specific feelings and appropriate ways of expressing them. (Behavior.16 Journal of Music Therapy ability of adults to identify/express feeling by using music listening with discussion. p< .01. in order of frequency.50%). delusions. songs were chosen about specific emotions.79%) and delusions (12. accomplishment. poor decision-making skills. or musical games (p = . poor decision-making.) As with affective problems discussed previously. The instrumental/vocal performance activities were engineered to produce patient feelings of success. Of these two. CTDs used music therapy to assessand treat certain adult cognitive problems significantly more frequently than other cognitive problems (x2 = 196. Cognitive.0119).002). Other adult cognitive problems assessed and treated. Of the above problems.40. Of the five music conditions reported.26. The overall goal was for the patient to understand and accept feelings as a part of life. music composition (p = . and denial of/withdrawal from problems.90. such as fear. p < . deficit problem solving.

and lacking self-respect and self-confidence. and the ability of the patient to accept or listen to the instructions. the music condition of choice for assessing/treating low adolescent self-esteem was vocal/instrumental performance activities administered both individually and in groups. XXXI. finding page numbers during group singing. With adolescents. lack of trust of others. group singing. the retention ability of the patient. clap your hands. minor incidents considered a threat). The assessment and treatment of overt behavior problems. When assessing the ability to follow directions. and paranoid behavior (e.019). and was the fourth most frequently assessed prob- . and following one-step. was the second most frequent type of problem assessed with children (17%). and low self-esteem. and significantly more often than paranoia (p = . 1994 17 sessed/treated most frequently were low self-esteem. then pat your knees. as well as cognitive and physical problems. then stomp your feet to the tune. Adolescents with low self-esteem were described as having a low sense of values/personal importance resulting in dysfunctional interpersonal interactions.g. making negative selfstatements. lack of problem-solving skills.09). behavioral problems were the fifth most frequently assessed problem. CTDs considered the difficulty of the instruction.. and body action songs. lack of directionality and spatial concepts. Behavior. No. experiencing feelings of worthlessness.Vol. Spring. Adult be havioral problems accounted for 10% of the music therapy assessment. As with adults. “If You’re Happy And You Know It”). accounting for 7% of the music therapy assessments administered by CTDs. Examples of specific activities were asking the patient to play a melodic/rhythmic pattern on the xylophone or drum during rhythm instrument activities. and/or multi-step directions during body action songs or simple dances (e. Low self-esteem was assessed and treated more often than deficit problem-solving skills (p = ..g. Following directions was assessed three times as often as self-esteem and twice as often as directionality and spatial concepts. the physical ability of the patient to follow the directive. The three most frequent cognitive problems assessed and treated with children were difficulty following directions. A variety of music conditions were suggested for assessing/ treating the ability to follow directions. including rhythm instrument activities. 1. two-step.

feels compelled to agree with the “right” answer. 1978). and running into people when in a group. or the answer given by peers). lack of assertiveness. CTDs occasionally observed anxiety or fears. skipping. and when the music should start or stop. including. and not expressing true feelings or opinions independent of peer pressure (e. evasiveness. When assessing the lack of inquiry skills. during song discussion. these assessments were not discussed. lacking inquiry skills. Because of the relative infrequency of behavioral assessments with adolescents and adults. CTDs unanimously chose music movement activities as the condition for assessing/treating such gross motor problems. Children with gross motor problems had difficulty performing basic movement tasks. in order of frequency. The music therapist would at times facilitate such discussions by posing problem solving or conflicting situations. tempo.16 Journal of Music Therapy lem. hitting peers. and poor eye contact. The physical problem assessed/treated most frequently with children was motor coordination. these assessments were not discussed. Unassertive children were described as not expressing their own needs. Verbal techniques included such activities as. or preoccupations.. As indicated above. Physical. Music conditions for assessing/treating unassertiveness employed both nonverbal and verbal techniques. and marching (Janiak. Examples included awkwardness when walking. An example of a nonverbal technique was having the patient conduct an instrumental ensemble in which the patient had to communicate dynamics.g. hopping. encouraging each patient to state opinions which agreed with or differed from those stated by the majority of patients. followed by physical communication/expressive language problems. Because physical problems accounted for less than 7% of adult assessments and were not assessed with adolescents. physical problems also were a second most frequent type of problem assessed with children (17%). Examples of activities were songs with lyrics that directed gross motor movements such as walking. creative movement to music in which children would mirror or lead movements of peers. attention deficit. CTDs reported a variety of childhood behavioral problems. not taking turns. and activities requiring children to imitate ob- .

p < . so they could participate in music activities.77. In addition. and children (x2 = 18.69.001). patients were involved in instrumental music activities which required them to push autoharp buttons to play the autoharp. sex differences emerged among adult patients. Spring. palmer or pincer grasp). 1. . The intrinsic reinforcement of the music conditions appeared to motivate the children’s desire to exercise the above gross and fine motor functions.01. significantly more music assessments were submitted for adult females (217) than for adult males (147) (Z = 3. p < . and grasp mallets to play resonator bells or tone bars. play finger cymbals.0006). Playing resonator bells also was suggested as one activity for remediating deficit eye-hand coordination. A follow-up analysis of individual assessment areas revealed adult females were given singing assessments (Z = 2. Unlike with nonmusic assessments.. 1976). Assessment and Treatment: Music Behavior Because of the above finding that 83% of all CTDs assess both nonmusic and music behavior. p < . lack of eye-hand motor coordination.0222) and locomotor movement assessments (Z = -2. For impaired grasp function.01). XXXI.30. Individual keyboard instruction emphasizing melodies and finger exercises involving all five fingers were employed to promote independent finger movement and general finger dexterity. finger strum the guitar.g. p < . CTDs prefer to assess certain types of music behavior significantly more frequently than others with adults (x2 = 148. adolescents (x2 = 19.Vol. Unlike gross motor problems. 1994 19 ject/animal movement such as walking like a turkey after doing the Thanksgiving Turkey Chant (Bitcon. difficulty grasping or manipulating utensils as a result of impaired grasp function (e. Fine motor problems assessed/treated by CTDs were lack of finger dexterity. instrumental performance activities were the music condition of choice for assessing/treating fine motor problems.29. and inadequate grasp maintenance as evidenced by the excessive dropping of objects frequently resulting in disruptions to others and embarrassment to self. p < . No. data were analyzed to determine procedures employed most frequently in assessing music behavior. grasp a guitar/autoharp pick. Grasp maintenance was developed by encouraging children to hold instruments such as the above.01).62.

41. listening to music and singing.42. p = .20 Journal of Music Therapy p < . adolescents. or composer significantly more often than more specific information such as familiarity with a variety of styles of music. p < .46.1112) approached significance as female assessments. recollections associated with musical preferences.27.22. Listening to music.00003).0003). composing music. and nonlocomotor movement to music.63. 51%. or composer.0778) and improvisation (Z = 1. performer. A cross tabs analysis of GAF.006). music composition (Z = -8. 47%. improvisation (Z = -4.0043). locomotor movement to music (Z = -6. listening to music and playing instruments. Procedures employed in assessing only the most frequent of these music behaviors are discussed in the following paragraphs. listening to music was assessed significantly more often than singing (Z = -2.00003).63. p = . p < . The two most frequent types of music behavior assessed with each CA level of patient followed by the percentage of time they were assessed in comparison to other types of music behavior were: listening to music and singing. It is noteworthy that music composition may be more appropriately used with higher functioning patients than those in the present study. When assessing adult music preferences.072) over the second most fre- . performer. The preference for using this music condition approached significance (p < . Listening to music (z = 1. sex. playing instruments (Z = -3. childhood. or knowledge of musical qualities or characteristics (Z = -2. and type of music activity revealed that music composition was employed significantly more often with male and female patients having above median GAF ratings compared to those having below median ratings (p < .0043). and nonlocomotor movement to music (Z = -9.16.00003).69. This was sometimes followed by the therapist performing the preferred song for the patient and inviting the patient to join in the singing of the lyrics. p < .0107) significantly more often than were males. p < . Adult music assessments for which no significant or nearly significant sex differences occurred were playing instruments. p< . adults. CTDs sought general information such as preference for a favorite style. The music condition employed most frequently to determine music preference was asking the patient to express preference for a favorite music style. With adults.00003). 49%. p< . p < .

singing.75.00. viewed as combined data.29. p = . the preference for assessing music listening over playing instruments approached significance (Z = -1. there was a nonsignificant tendency for the adolescent assessment to be focused toward obtaining specific rather than general information about music preference. listening and singing were each assessed significantly more often than composing music (p = . p = . and improvisation (p = .00003). and nonlocomotor (Z = -4. Having children identify specific information about music. 1. and playing instruments were assessed significantly more often than composing. The music condition CTDs used to assess music listening with children was almost diametrically opposed to the condition they utilized with adults. p = . It is interesting to note that eliciting verbal preference by asking the patient was used significantly more frequently than administering a questionnaire to determine music preferences (p < . nonlocomotor movement to music (p = . music listening was assessed significantly more often with adolescents than was improvisation (Z = -1. Although listening and singing were assessed more often than playing instruments and locomotor movement to music. p < .75.XXXI. composing music (Z = -1. No. Also. improvisation.56%). and was a continuation of the trend established with adolescents.0401). approached significance in frequency over having children state their music preferences (p = . indicating a lack of consensus among CTDs as to which condition to use. The assessment of adolescent music preference also differed from adult assessment in that a variety of music conditions were reported with equal frequency. style. However. singing (Z = -1. p = . When assessing singing.00003).055).0401). Unlike music listening assessment with adults.0764). CTDs most often observed the ability of children to sing on .Vol.018). 7994 21 quent music condition of asking the patient to select from a collection of recordings or albums a song to play for the group. and tempo.43. Spring.015). the difference was nonsignificant. With adolescents. Compared to other music behaviors.015). or locomotor movement to music (Z -4. and was employed significantly more often than each of 14 other reported music conditions (p < .75. such as characteristics.002). instrumentation. listening.0401). p = . Listening to music and singing were assessed with equal frequency with children (24.011).

83. 7. match pitch. 8. 8. perpetuates. 1989). 8. 7. grooming. 1986). . 3.78.39. facial expression. 6. 6.. retention (Cohen & Gericke. 1972). or solves problems during music activity.70.49. Musical interest (NAMT. Patient-directed questions (nonmusically oriented) to reveal the patient’s self-concept (Braswell et al. etc. 5. 5. etc. 1972). lyrics of songs. to reflect feelings or emotions as an escape.82. attention span.61.00.). 6. 9. Patient’s use of music (artistic. Patient-directed questions (nonmusically oriented) to reveal the patient’s self-concept. and sing Following are the IO adult activity therapy assessment areas considered most important by CTDs. 4.22 pitch or in tune.. The 10 activity therapy assessment areas considered most important by CTDs for adolescents were: 1.. grooming.09. posture. 6. 7. 9. motivation.57. 1972). 8.00. 2. etc.86. 5. 7.81. ability. Interpersonal relationships. 5. Activity Therapy Assessment Journal of Music Therapy sing melodic phrases. attention span. retention. 2. Type of music liked (Cohen & Gericke. Creativity. etc. attention span. posture. Abstracting (Cohen & Gericke. Attitude toward music. Type of music liked. 1972).26. 10. 6. 1972). 1972). 1986). Concentration. Concentration.) (Cohen & Gericke. 7.12. 6.80. Observation of patient’s nonmusic behavior (eye contact. 1986). 6. motivation.) (Braswell et al. and impediments (Cohen & Gericke. attention span.). 1972). How patient perceives. 8.83. or solves problems during music activity (Cohen & Gericke. 7. conversation. perpetuates. 8. 5. facial expression. Observation of patient’s nonmusic behavior (eye contact. 4. as an escape. 8. to reflect feelings or ernotions. conversation.11. 3. 9. Interpersonal relationships (Braswell et al. How patient perceives.65. How patient uses music (artistic. Attitude toward music (Cohen & Gericke. 7. followed by the source of the area. and the mean rank CTDs assigned each area: 1.

5. How patient perceives.50. How patient uses music (artistic. grooming. perpetuates. 8. and impediments. Implications for the practice of music therapy are discussed in the following sections.00. perpetuates.XXXI. Spring. or solves problems during music activity. The rankings identified herein indicated that. 5.). retention. 1994 23 10. etc.89. 3. For childhood. 8. 6. level of functioning. How patient perceives.02. Concentration. 8.38. posture. although some music assessment was necessary when doing activity therapy. Type of music liked. The assessment of music behavior. etc.Vol. 5.91.). and encompasses patient diagnoses. attention span. areas of assessment. 10. 6. 7. and music therapy interventions. or solves problems during music activity. Creativity. specific patient problems assessed and treated. motivation. the activity assessment areas CTDs considered most important were: 1.69. 6. 8. Rhythmic ability (Cohen & Gericke. 6. 1. 9. Observation of patient’s nonmusic behavior (eye contact.75. as an escape. 2. ability. 4. The commonality is significant and extensive for all CA levels of patients. Existence of handicapping conditions that may impair activity participation (Cohen & Gericke. 8.50. facial expression. 7. conversation. Attitude toward music. 1972). to reflect feelings or emotions. Interpersonal relationships. . such as “type of music liked” primarily was to facilitate the planning of appropriate music therapy activities. Discussion This study examined 200 patient problems CTDs treat in psychiatric clinical training facilities and 801 music conditions they employ to treat the problems to determine the extent to which a common body of knowledge exists in psychiatric music therapy assessment and treatment. It may be concluded that a common body of knowledge exists in psychiatric music therapy.50.88. CTDs placed primary emphasis on assessing nonmusic rather than music behavior. 1972). 9. No. attention span.

To enhance external validity. the information may be used as a framework and a guide in future psychiatric music therapy research. For example. to enhance external validity or generalization to the survey population (clinical training centers/directors). The results of this study contain implications for the production of a standardized assessment. Although a treatment manual was produced (Cassity & Cassity. but also to assesswhether they are acquiring healthy living skills that may assist in preventing future problems. Assessment The present study indicated 79% of all CTDs believed a standardized music therapy assessment of nonmusic behavior was needed. as reflected in-the present study.. and 92% of all CTDs believed a psychiatric music therapy treatment manual was needed. “No profession. 92). Bruhn and Patterson (1992) found that senior citizens not receiving music therapy expressed significantly decreased life satisfaction. multiple testing sites should be assigned to test single interventions to determine their effectiveness at treating patient problems.24 Research Journal of Music Therapy Because information in this study represents the common practice of music therapy. Averbach. and Katz (1978). 1993). 1985). the task of producing a standardized psychiatric music therapy assessment remains. Experimental formats for future large-scale experimental testing of the psychiatric music therapy interventions identified in this study should be designed and distributed nationally for testing in music therapy clinical training facilities and other qualified psychiatric facilities. can legitimately attain true professional stature without a viable assessment system. the intake assessment . 1986. any future standardized psychiatric music therapy intake assessment should be designed to assess patient problems music therapists assess most frequently. First. According to Cohen. A second consideration relates to the need for such an assessment to be brief (Braswell et al. not only to determine whether patients are improving in daily life functioning. not merely the completion of an assessment form” (p. If both brevity and external validity are to be achieved. The evaluational goals should be broad based. Cassity. whether it is music therapy or another discipline.

A third consideration involves the format for administering such an assessment. the music therapy clinician could then use the clinical manual as a reference to suggested interventions applied most frequently by CTDs in treating the assessed problems. These instruments did not. 1982. iii). “sometimes radically different” (Michel & Rohrbacher.Vol. if it were designed to assessproblems treated most frequently by music therapists. An examination of the assessment instruments indicated that most instruments were designed to assessnonmusic behavior by interviewing the client or having the client fill out a questionnaire. This especially is true in the sense that music therapy assessment is an ongoing process which continues during the treatment phase. p. Such procedures were supported in the assessment instruments submitted by CTDs in the present study. The consideration proposed in this study. Such an assessment would be similar to diagnostic assessments administered by related professionals with the exception that it would assess patient music preferences as well as problems music therapists treat most frequently. Assessments given by other professionals do not focus exclusively on problems treated most frequently by music therapists. Eliminating music conditions from the initial intake assessment would also contribute to brevity of the assessment. Following administration of the intake assessment. Standards Information from the present study should be considered when formulating future standards of practice for psychiatric . No. contain the patient problems/areas of assessment music therapists assess most frequently. is that an initial psychiatric intake assessment may not always need to be administered under music conditions to distinguish it from assessments given by other professionals. contain suggested music therapy interventions for assessing/treating patient problems. 1994 25 should. nor did they indicate the level of functioning of the patients for whom they were designed. however. Past literature indicates that one aspect of the music therapy assessment which uniquely distinguishes it from assessments given by other professionals is that behavior under music conditions may be different. Caution should therefore be exercised in any future attempts to describe music therapy practice by soliciting assessment instruments. 1. XXXI. however. again. Spring.

however. 1993. because of the differing assessment needs of different CA levels of clients. assessment areas that were not among the five most frequently assessed areas were assessed by a minority of CTDs. These areas. and Infancy. Sensory capacity was assessed slightly less frequently than speech. In the present study. Childhood. include motor development. and sensory integrative functioning. p. poor quality of communication. visual and auditory hallucinations. only 2. 1990). 1990). The Standards state under 2. poor communication skills. which also indicated adult speech problems were assessed by a minority of music therapists (Cassity & Theobold. physical.77% of the problems listed were motor. Cassity & Theobold. The present study indicated that a significant com- . Although CTDs reported adult speech problems such as difficulty or inability to communicate verbally with others. it is recommended that the Standards provide for CA level differences within the category of Developmental Disabilities. or sensory integrative problems. such problems accounted for only 3. speech development.70% of the problems CTDs reported assessing. and slurring speech. 1985. In addition. speaking incoherently. Competency Examinations Consideration also should be given the findings of the present study when constructing future music therapy competency examinations. physical abilities. previous research (Cassity. when CTDs were asked to list five assessment areas and ten problems they assessed most frequently.9 that “Music therapy assessment shall address the following areas” (NAMT. mandated for assessment.26 Journal of Music Therapy music therapy. Numerous areas mandated for adult psychiatric assessment in the National Association For Music Therapy Standards Of Clinical Practice (1993) were infrequently assessed in NAMT-approved clinical training facilities. Speech is another infrequently assessed area. This finding was supported by previous research. these problems represented only 3. and difficulty coping with stress and tension. Although music therapists reported assessing sensory problems such as internal thoughts. Information from this study.88% of the total number of patient problems reported. Finally. and future research could be used in writing assessment mandates for the proposed categories of Adolescence. sensory capacity. 5).

then it is recommended that future surveys control for CA. 1993. if the survey and the resulting examination are “to accurately reflect current practice in the music therapy profession” (CBMT. information from the present study. Using this procedure.Vol. it also is recommended that future job analysis surveys and competency examinations enhance control over CA. Such a combination of distorted and undistorted ratings would inhibit a valid comparison of the relative importance of each test item. . appropriate music therapy interventions for the problems were not surveyed. could be used as a reference for determining the representativeness of solicited competency test items. 1993. then it would seem logical that music therapy interventions commonly used to assessthe problems should also be important knowledge. In addition to enhancing job analysis efforts. p. p. Although it may be argued that overall ratings were sought. 1990). 1). especially the clinical manual resulting from the study. p. The above procedure may thus have transformed CA into a confounding variable. Although the Job Analysts Survey (The Certification Board for Music Therapists (CBMT). in a second column. 1993) included some of the assessment areas and patient problems reported in the present study. If knowledge of commonly assessed areas and problems is considered important. Spring. it would have been difficult to determine CA differences in the data since many music therapists work with more than one CA level of patient or equally differing CA levels. 1994 27 mon body of knowledge exists in terms of areas assessed. 5). 1993) requested respondents to check the CA of the population with which they spend most of their time and. to check the ages of all other patients with whom they work. Because of the significant differences in music therapy practice according to CA level indicated in this study and in previous research (Cassity. specific problems assessed. such as “observe client in musical and nonmusical situations” (CBMT. 5) may have been distorted since the importance of such an assessment is dependent on patient CA.XXXI. 1985. Responses to survey items such as “identify manifestations of client’s affective state” (CBMT. 1. and types of music therapy interventions used to assess/treat the problems. 1993. The Job Analysis Survey (CBMT. Cassity & Theobold. In contrast. No. ratings for items uninfluenced by CA would not likely be distorted.

85-27959. (1990).C. Journal of Music Therapy.. Multimodal therapy and music therapy: Assessingand treating the whole person. Diagnostic and statistical manual of mental disorders-revised (DSM-III-R). (1976). Changing concepts in treatment. & Theobold. OK. C. E.: Author. (1993). Humphrey. 6. 2955).. American Psychiatric Association (1967). L. Santa Ana. (1992). & Cassity. adolescents. Music Therapy. & Quattlebaum. . Alike and different. CA: Rosha Press. M. M. Development and implementation of a music/activity therapy intake assessmentfor psychiatric patients. 10A. 46. Although information produced from this study is not intended to provide a cookbook approach to music therapy. 179-194. Jacobs. Journal of Music Therapy. & Patterson. Techniques. Such knowledge may serve as essential cognitive background for designing unique music therapy strategies for atypical patients.26 Journal of Music Therapy Education Finally. Bitcon. K. (1967). K. (1986)... & Sutton. J. Carroccio. D. D. M. group cohesiveness. F. The influence of a music therapy activity upon peer acceptance. D. procedures and practices employed in the assessmentof adaptive and music behaviors of trainable mentally retarded children. C. 108-109. F. Journal of Music Therapy. E. Dissertation Abstracts International. OK: C&C Publications. Cassity. (1969). Unpublished manuscript. it should be useful in providing students with a knowledge of the most common practices employed in psychiatric music therapy. H. 23. D. and children: A Clinical Manual.. D. Weatherford. A. D. Journal ofMusic therapy. K.. M. W.. C. Part If: Standardization procedures on data from psychiatric patients. 4. 5. The effect of music therapyon senior citizens. Domesticviolence: Assessmentsand treatments employed by music therapists.. 126-141. B. (1976). (1965). Decuir. The results of this study should serve as a guide for training students in clinical practices that they most likely will encounter during psychiatric clinical training. D. Weatherford. 12-21. Southwestern Oklahoma State University. Brooks. Bruhn. An elementary technique for manipulation of participation in ward dances at a neuropsychiatric hospital. Washington. and interpersonal relationships of adult psychiatric patients. it is recommended that information from this study be used to coordinate education with clinical practice. A. Cassity.. Journal of Music Therapy. MichCassity. (Ann Arbor. 13. (1965). Braswell. T. igan: University Microfilms International No. 27. Braswell. References Adelman. 63-66. 66-76. Multimodal psychiatric music therapy for adults. Cassity. J.

(1976). Journal of Music Therapy. L. Washington. K. C. Jones. of GeneralPsychiatry. (1965).. W. G. MD: National Association for Music Therapy.. A comprehensive dictionary of psychological and psychoanalytical terms.. 9.. Music Therapy. 27. National Association for Music Therapy. MD: Author. B. English. Inc. Frostig developmental test of visual perception (3rd ed. Cohen. B. 1. R. 766-771. (1972). Silver Spring. MD: Author. Circle Pines. Standards of clinical practice. Insight therapy: Guided imagery and music in a forensic psychiatric setting. E. Dubuque. (1986). G. National Association for Music Therapy. CBMT Job analysis survey. Inc. Teaching music to the exceptional child: A handbook for mainstreaming. The use of songwriting in a psychiatric setting. Graham. E. Assessing developmental levels of mentally retarded students with the musical-perception assessment of cognitive development. (Eds. (1958).). Spring.. Music therapy for mentally retarded children and adults. E. Silver Spring. An introduction to music therapy: Theory and practice (pp. C. H. J. H. R. Inc. (1992). XXXI. 3. Music Therapy. 1994 29 Certification Board for Music Therapists (1993). Palo Alto. Music therapy assessment:Prime requisite for determining patient objectives. 3. L. (1978).: American Association on Mental Deficiency. Music therapy assessmentof the developmentally disabled client.. New York: David McKay Company. Jensen. Tucson. S. Role of music therapy in the education of handicapped and youth. J. research draft III. The music therapy profile Silver Spring. Journal children of Music Lathom. Archives & English. L. Davis. E. Cohen. Songwriting with the chemically dependent. 43-51. Music Therapy Perspectives. 15. 161-189. & M. IA: Wm.) (1982). Michel. & Beer. Songs for music therapy. W. C. for severely/profoundly handicapped . Brown Publishers. Englewood Cliffs. Averbach. J. Ficken. 166173. T. Janiak. Inc.C. (1980). Fleiss. 84-89). Vineland social maturity scale. Manual on terminology and classification in mental retardation. Gfeller. Doll.. Thaut (Eds. MN: American Guidance Service. J. (1993). (1989). P. & Katz. Inc. 23. No. (1987). AZ: Author. Noland. B. The global assessment scale: A procedure far measuring overall severity of psychiatric disturbance. Long Branch. A. Therapy. MD: National Association for Music assessment persons. Therapy. J. Journal of Freed. & Cohen. 158-178. M. In W. O. & Rohrbacher. 61McKinney.Vol. M. Frostig. (1980).A. (1990). 4. (1977). 13-18. Journal of Music Therapy.. W. D. H. Davis.. L. A. R. D. M. S. 33(6). Sample job descriptions. NJ: Kimbo Educational. (1963). Endicott. K. 88-99. H.). NJ: Prentice-Hall. (1978).Spitzer. Inc. Silver Spring. 43-51. Undergraduate music therapy education and training: Current status and proposals for the future. B. (1976). CA: Consulting Psychologists.. Journal of Music Therapy. & Gericke. Grossman. (1983).

(1983). M. 1. Swan. 114-117). Davis. (1976). 49-53. W. C.30 Journal of Music Therapy Rider.. sociation For Music Therapy. Gfeller. Graham. Thaut. Thaut (Eds. Developmental music therapy. M. 18. K. Rubin. E. B. Music therapy in the treatment of mental disorders. S. L.. MA: Houghton Mifflin. M. Wood. B.. W. An introduction to music therapy: Theory and practice (pp. K. & Samet. Brown Publishers. In W. & M. Wheeler. M. (1981). A.). L.. Purvis. Silver Spring. M. Boston. Terman. 13. Music Therapy Perspectives. Handbells in therapy.. Gigliotti. Journal of Music Therapy. & Merrill.. H. B. MD: National As8-12. IA: Wm. C. E.. M. 110-119. H. . (1960). A psychotherapeutic classification of music therapy practice: A continuum of procedures. (1974). Journal of Music Therapy. J. M. (1992). Inc. Dubuque. & Gfeller. Revised Stanford-Binet intelligence scale. S. R. The assessment of cognitive functioning level through musical perception.

on autistic children’s communicative behaviors. designed specifically for this study..D. language development deficit is one of the symptoms necessary for a diagnosis of autism. participated in individual improvisational music therapy sessions for a period of 10 weeks. . ranging in age from 6 to 9 years. Eleven autistic children. A reversal design was applied. Since then. Kanner (1943) devoted a large amount of attention to their communication deficits. abrupt and substantial decreases in scores were noted for all 11 subjects when reversal was applied. Charlotte. Also. Ph.The Effect of Improvisational Music Therapy on the Communicative Behaviors of Autistic Children1 Cindy Lu Edgerton Michigan State University The purpose of this study was to determine the effectiveness of improvisational music therapy. Ml 48813. RMT-BC. for their support and guidance throughout this study. Results strongly suggest the efficacy of improvisational music therapy in increasing autistic children’s communicative behaviors. research has continued to support Kanner’s observations of the numerous problems related to autistic children’s communication development. Correspondence regarding this article should he addressed to Cindy Lu Edgerton.. based on Nordoff and Robbins’ (1977) Creative Music Therapy approach. The Checklist of Communicative Responses/Acts Score Sheet (CRASS). The acquisition of language is crucial to the prognosis for autistic children. The presence of useful speech by 5 years of 1The author gratefully acknowledges Roger Smeltekop. 443 Forest. In the first description of children diagnosed with early infantile autism.01). was used to measure the subjects’ musical and nonmusical communicative behaviors. Significant differences were found between the subjects’ first session CRASS scores and those of their last sessions (p < . M. and Dale Bartlett. According to the National Society for Autistic Children (1978) and the American Psychiatric Association (1987).M.

1989). 1989. He concluded that both the mute and the verbal children were the same as far as meaningful communication was concerned. 1956). Autistic children have been found to have deficits in means-end behaviors (Abrahamsen & Mitchell. 1990). & Steel. intentional communicative behaviors/vocalizations (Ball. DeMyer. literalness. & Zee. & Fish. Rutter (1978) and Gillberg and Steffenburg (1987) found that functional language skills demonstrated by early school age were as powerful as intelligence in predicting autistic children’s later skills. 1989). Frith (1989) points out that. 1985). 1963. 1978). 1989. communicative functions (Landry & Loveland. Brown. comprehension. 1984). Current views of these characteristics focus on difficulties in pragmatics. which are now seen as a universal feature of autism (Frith. Simmons. Chiarandini. verbal. Norton.32 Journal of Music Therapy age was one of the most significant distinguishing characteristics between autistic children rated as making poor adjustment and those who made good adjustment (Eisenberg & Kanner. he noted the following specific characteristics of their language deficits: muteness. The belief that echolalic behaviors serve no significant communicative purposes has been challenged. metaphorical substitution. and pronoun reversals. Further research confirmed the finding that the degree of language development by ages ranging from 30 months to 6 years is predictive of later development (Bagley & McGeein. spontaneous speech (Shapiro. and structural changes. or how language is used for various purposes. Echolalia and stereotypical language of autistic children can be analyzed according to communicative intent. numerous questions remain unanswered. but it is not yet known why (Frith. repetitions. Allen. simple verbal negation. and motor imitative skills (Dawson & Adams. 1974). Stone & Lemanek. initiation of contact with others (Watson. . even though more has been written on the language impairments of autistic people than on any other of their deficit areas. 1984). social communication skills (Attwood. Kubicek. 1990). Barton. immediate and delayed echolalia. 1985). 1980). Kurita. 1984. At least three-quarters of all speaking autistic children demonstrate echolalia. 1984. DeMyer. gestural. Wetherby & Prutting. In Kanner’s (1946) description of autistic children. and prosodic development (Baltaxe. 1973.

conducted by the Intellectual Disability Review Panel (1989) in Melbourne. 1981) and 9 of the 20 categories of delayed echolalia (Prizant & Rydell. This shift focuses on accepting each child’s language impairment and working toward his/her optimum potential in communication development (Schopler & Mesibov. structured intervention approaches are frequently recommended. The most recent intervention technique for people with autism is facilitated communication. XXXI. Throughout the research and literature pertaining to autistic children. This method is based upon a praxis theory. No. “Echolalia and stereotyped language are now seen as primitive strategies for communicating. There has been a change in emphasis from teaching language skills to teaching communication skills due to the importance placed on functional communication. 72). 1990). Only one research study on facilitated communication. Current trends in language intervention programs with autistic children are numerous. which presumes that autistic people have a neurologically based deficit. not in comprehension.Vol. A high degree of structure is seen as an essential element in autistic children’s treatment plans (Thaut. 1. but in expression. Tager-Flusberg (1985) stated. Facilitated communication uses an electronic typing device and allows for education through dialogue and personal expression. This study produced support both for people who claimed facilitated communication was valid and for those who doubted its validity. has been published to date. treatment appears to have only a modest effect on long-term language adjustment. Spring. Australia. However. 1985). In reviewing the research of education approaches. where both the stimuli and the child’s responses are determined by the adult. Intervention programs have demonstrated success in autistic children’s socialization and communication achievements. Clarizio & McCoy (1983) found general agreement that autistic children learn best in structured environments. a method developed by Rosemary Crossley (Biklen. especially in the context of poor comprehension” (p. 1980). Many reports from clinical observations and experiments with . 1984) are interactive. 1994 33 The results of two major studies indicated that four of the seven types of immediate echolalia (Prizant & Duchan.

Saperston (1973) used improvised music to establish communication with an autistic child who had not previously appeared to experience any type of communication. 1969). Numerous case studies by Nordoff and Robbins have illustrated and corroborated the many values of Creative Music Therapy. 1979. attention span (Farmer. Rimland. Watson. 1953. improving interpersonal relationships. Saperston. 1990. Goldstein. 1964. task accuracy (Burleson. Goldstein. vocal and instrumental improvisation aided in establishing communication. 1982). spontaneous speech (Miller & Toca. 1963. Mahlberg. 1964). interpersonal relationships (Goldstein. Saperston. & Reeves. 1980. Nordoff and Robbins (1964. The literature most relevant to this investigation has focused on improvisational music therapy techniques. Koegel. 1982). 1979). 1964). Sherwin. 1979. Creative Music Therapy. positive effects were found in the children’s prosocial behaviors (Stevens & Clark. Hollander and Juhrs (1974) used Orff Schulwerk activities to help severely autistic children invest in a meaningful group experience. Center. and to help develop a relationship of trust and enjoyment for autistic children and their mothers. 1979. and decreasing pathological behaviors (Nordoff & Robbins. & Imhoff. 1973. 1964. 1964. self-expression (Cecchi. Anderson. 1973). 1968a. 1971. providing a means of self-expression. DeMyer. 1982). Saperston. Egel. Working with a 3½-year-old autistic boy. 1979. Thaut. 1964. 1977) have done extensive work using improvisation with autistic children. Their technique. Nordoff and Robbins (1968a) used improvised music with a 6-year-old autistic girl who demonstrated progress .34 Journal of Music Therapy autistic children emphasize their special responsiveness toward and unusual interest in musical stimuli (Applebaum. Alvin and Warwick (1992) reported on the use of improvisation to facilitate interactions. and shopping skills (Staum & Flowers. In studies investigating the use of structured music therapy techniques with autistic children. Mahlberg. 1980). 1984). Kolko. mental age (Goldstein. to provide for self-expression. & Campbell. 1989). emphasizes the creation of musical improvisations which serve as a nonverbal means of communication between the therapist and the child. vocal imitation skills (Miller & Toca. In another study.

Vol. XXXI, No. 1, Spring, 1994


in increased vocabulary, self-expression, and the spontaneous use of personal pronouns. In establishing a therapist-client relationship with a 5-year-old boy who exhibited autistic features, Nordoff and Robbins (1977) used improvisational techniques through both drum/cymbal-piano and vocal interaction activities. Progress was noted in several areas, including an increase in vocabulary, development of spontaneous and communicative speech, development of conversational jargon, and acceptance of change and novel situations. Although numerous case studies have demonstrated many therapeutic values of Creative Music Therapy, no controlled experimental studies of improvisational techniques based on Creative Music Therapy were found. Therefore, the purpose of this study was to examine the effects of improvisational music therapy upon the communicative behaviors of autistic children. Specifically, the following research questions were proposed: 1. Is there a significant difference between the number of total communicative behaviors as measured by the Checklist of Communicative Responses/Acts Score Sheet (CRASS) demonstrated by autistic children in their first improvisational music therapy sessions and the number demonstrated in their last sessions? 2. Is there a significant difference between the number of Communicative Responses/Acts demonstrated by autistic children in their first sessions and the number demonstrated in their last sessions in each of the following subcategories of the CRASS: tempo, rhythm, structure/form, pitch, speech production, communicative-interactive, and communicative intent? 3. IS there a significant relationship between the subjects’ musical vocal behavior score changes and their nonmusical speech production score changes as recorded on the CRASS? 4. Will any changes in the autistic children’s communicative, social/emotional, and musical behaviors be observed by the parents, teachers, or speech therapists outside of the music therapy setting at the conclusion of the IO-week period? 5. Are there significant relationships between the autistic children’s overall CRASS score changes and the parents’, teachers’, or speech therapists’ total ratings on the Behavior Change Survey?


Journal of Music Therapy

Method Subjects Eleven autistic impaired subjects (ten males and one female), ranging in age from 6 to 9 years, participated in this study. Subjects’ diagnosis of autistic impaired ranged from severely to mildly impaired. Deficits in communication skills were common to all of the subjects. Language ages, measured by standardized tests and/or observation and reported by speech therapists and/ or teachers, ranged from “no formal means of intentional communication” to 5 years. Five subjects were nonverbal, and four subjects demonstrated limited functional language skills. Materials/Settings The following musical materials were used in the treatment procedure: a piano, a snare drum with the snare removed, and a 16-inch cymbal. The snare drum and cymbal were mounted on adjustable stands. The height and tilt of the snare drum and cymbal were adapted for each child to allow for successful attempts at beating. A chair was available for the subjects, and the experimenter was seated on a piano bench. A variety of beaters were also available, including regular medium-weight drumsticks, both heavy and light tympani mallets, and one pair of brushes. A videocamera was also in the room. The study was conducted in three different settings: two elementary schools and a music therapy clinic. Two of the rooms were similar in size and content; the other was a music education room that was larger and contained a variety of musical materials/instruments. An area within this room which resembled the other two rooms was set up for the experiment. The experimenter and each child were alone in the room with the exception of a few unanticipated interruptions. Measurement The dependent variable in this study was communicative behaviors. Consultations with speech therapists and a search of relevant literature revealed no standardized test that evaluates musical and nonmusical communicative behaviors for autistic children. Nonmusical communicative responses of autistic children are evaluated through a variety of standardized tests. Nor-

Vol. XXXI,NO.1. spring, 1994


doff and Robbins (1977) developed a musical communicativeness scale with established reliability; however, this reliability was established using music therapists who were specifically trained in the Creative Music Therapy technique (C. Robbins, personal communication, May 26, 1992). Therefore, an original checklist, Checklist of Communicative Responses/Acts Score Sheet (CRASS), was constructed by the experimenter. Each of the behaviors listed on the score sheet was operationally defined. The CRASS was based on items from numerous rating scales and assessments for musical communicativeness, autism, and communication skills (Brigance, 1978; Bzoch & League, 1970; Krug, Arick, & Almond, 1979; Nordoff & Robbins, 1977; Ruttenberg, Dratman, Fraknoi, & Wenar, 1966; Stillman, 1978; Uzgiris & Hunt, 1975; Wetherby & Prutting, 1984). The CRASS was divided into two categories: musical and nonmusical. Communicative Responses were defined as verbal, vocal, gestural, or instrumental behaviors demonstrated by the child which are influenced by the experimenter’s improvisation, e.g., matches a fast basic beat, simultaneously imitates the rhythm of a melodic motif, participates in a rhythmic give-and-take, etc. Verbal, vocal, or instrumental behaviors initiated by the child in an attempt to influence the experimenter’s improvisation/behaviors or for the purpose of independent expression were categorized as Communicative Acts (e.g., creates a rhythmic pattern, develops a melodic give-and-take, spontaneously creates a new melodic phrase, etc.). Behaviors which served as prerequisite skills necessary for musical communication were also categorized as Communicative Acts (e.g., beats within a tempo range, vocalizes, etc.). Within the musical category, operationally defined Communicative Responses and Acts were listed under four subcategories: tempo, rhythm, structure/form, and pitch. In the nonmusical section, operationally defined behaviors were categorized according to speech production skills, communicativeinteractive skills, and communicative intent skills. The CRASS contained a total of 107 items, with 91 items in the musical category and 16 items under the nonmusical category. Sixty-nine items were categorized as Communicative Responses, and thirty-eight items were categorized as Communicative Acts.


Journal of Music Therapy

Time interval sampling was used, with one lo-minute interval randomly selected prior to each 30-minute session. The sessions were videotaped for data collection purposes. During the one lo-minute interval, two observers independently recorded the communicative behaviors of each child using the CRASS. The observers were senior undergraduate music therapy students. A check was given for each behavior observed, with a maximum of one check recorded for each behavior, even if that particular behavior was repeated. The checks were then tallied, resulting in a total Communicative Responses/Acts score per subject per session. The second observer served as a reliability check throughout the study. Interobserver agreement was calculated for both occurrences and nonoccurrences using the following formula: agreements divided by the sum of agreements and disagreements. Interobserver reliability for occurrences ranged from 75% to 100%, with a mean of 86.2%. For nonoccurrences, interobserver agreement ranged from 77% to 100%, with a mean of 94%. The second measurement device used was the Behavior Change Survey, which was given to parents, teachers, and speech therapists for each subject immediately following the conclusion of the study. There were five questions related to communicative behaviors, six questions related to social/emotional behaviors, and two questions related to musical behaviors. A sevenpoint rating scale was used to indicate the number of changes seen in the subject’s communicative, social/emotional, and musical behaviors. The numbers, in sequence from “1” to “7,” represented the following descriptions: much less, somewhat less, slightly less, same, slightly more, somewhat more, and much more. Procedure A reversal design was used, consisting of the following phases: (a) intervention, (b) one-session withdrawal of intervention after a level of consistency in responses was achieved, and (c) reintroduction of the intervention. Each subject was scheduled for one 30-minute session per week for 10 weeks. Due to illnesses and unforeseen circumstances, two subjects were not able to attend all 10 sessions. One

Reversal consisted of the experimenter playing and singing structured precomposed music as opposed to improvised music. verbal invitations. The use of written music . Many of these techniques were taken from the book. and to facilitate development of the child’s musical communicativeness. Intervention consisted of improvisational music therapy. by Nordoff and Robbins (1977). dependent upon the child’s responses. The first intervention phase continued until consistency in responses was noted. Specific techniques used were decided in the course of the music therapy sessions. The following two basic principles were followed with all of the subjects: (a) Each child was treated as competent. Numerous techniques listed in the hierarchy (114 specific techniques) were available to the experimenter to allow for flexibility within each session in creating an atmosphere for the child in which optimal growth and development could occur. The experimenter created music to establish contact with the child. and/or develop the child’s responses.XXXI. A complete copy of the hierarchy is available upon request. No. 1994 39 subject attended eight sessions. During this phase. and it was assumed that he/she understood all that was said and was capable of musically expressing him/herself. and (b) total emotional support was provided for each subject. to enable the child to respond. Creative Music Therapy. Due to the fact that all subjects’ measured responses showed an ascending baseline by the sixth session. Gestural invitations. and each child had opportunities to play instruments and to sing. based on Nordoff and Robbins’ (1977) Creative Music Therapy approach. The experimenter worked freely within the hierarchy of musical experiences/activities. all reversal sessions occurred in Session 6.Vol. 1. The experimenter played the piano and/or sang. and the other subject attended nine sessions. maintain. and needs. capacities. A hierarchy of musical experiences/activities was provided as a guiding reference for ongoing decisions made by the experimenter throughout the intervention sessions. Spring. with the experimenter remaining as responsive as possible to each child and conveying acceptance of him/her. and reinforcements remained the same. the experimenter continued to evoke.

These songs were then repeated during the lo-minute data collection interval. 1968b). intervention was continued as explained above for the remaining sessions. preselected music therapy activity songs were played and sung. “Charlie Knows How to Beat the Drum” (Nordoff & Robbins.3. with a mean of 22. These figures reveal individual differences in the total number of Communicative Responses/Acts and in the degree of improvement in the CRASS scores over the 10 sessions.6 During the second intervention phase. This level was reversed immediately upon reintroduction of treatment procedures. 1962). 1989). Songs used during reversal included “I Have a Song to Sing” (Cross. “Drum Talk” (Nordoff & Robbins. 1989).40 Journal of Music Therapy added additional materials and decreased the amount of eye contact during the reversal phase. showing an increase in the CRASS scores during both intervention phases and a decrease in these scores during reversal for each individual. The songs. provided opportunities for each child to respond in all of the areas listed in the CRASS. “3/4 and Strong” (Dubesky. An overall increase in total scores was noted for the group as a whole. In the initial intervention phase. Results Figure 1 shows group mean Communicative Responses/Acts for each session. .3. along with an abrupt decrease in the total group mean score during the reversal (Session 6). however. with a mean of 11. the level of change for all subjects was in an improving direction ranging from 8 to 40 points.3. Decreasing level changes ranged from 9 to 37 points. which was randomly chosen prior to the session. chosen prior to implementation of the study. Following the reversal. with a mean of 18. the level of change was in an improving direction and ranged from 6 to 17 points. with a mean of 19. Increasing level changes from the reversal to the reinstatement of intervention ranged from 10 to 43 points. 1982). an overall trend was demonstrated. During the first 10 minutes of the reversal session. Figures 2-12 show individual graphs for each subject. Withdrawal of the intervention resulted in an abrupt and substantial decrease in the quantity of Communicative Responses/Acts. and “It’s Music” (Dubesky.

xxxI.1. Ail 22 conditions showed a stable trend. Criteria for trend stability was set at 80% of the data points falling within 15% along the trend line (Tawney & Gast.vol. Trend stability within conditions was determined for both intervention phases for each subject. The Wilcoxon Matched-Pairs Signed-Ranks Test was used to . spring. 1994 41 Group Mean Scores Responses Sessions Figure 1 Group Mean Communicative Responses/Acts across 10 Sessions A positive acceleration trend was noted in both intervention phases for all 11 subjects. NO. 1981).

the differences between the scores were significant at the . determine if a significant difference existed between subjects’ scores of their first and last sessions.01 level (T = 0). Therefore. questions emerged concerning the validity of the first session scores. a statistical . Taking into account that one of the characteristics of autistic children is resistance to change.Subject A 70 i Figure 2 Communicative Respones/Acts of Subject A across 10 Sessions. Figures 2-12 show that all of the subjects’ last session scores were greater than their first session scores. Consequently.

Therefore. the third session scores may have been more accurate in portraying the communicative abilities of the children at the beginning of the . Responses/Acts of SubjectB across 10 Sessions. 1. NO.vol. Using the third session scores instead of the first session scores in the analysis was based on the assumption that. by the third session. spring. analysis was computed to determine whether a significant difference existed between the subjects' third session scores and their last session scores. 1994 43 Subject B Responses 70 I 4 5 6 7 6 9 10 Sessions Communicative Figure 3. xxxi. the subjects were not viewing music therapy as a change in their routine.

Figure 14 shows the group mean scores in each of the three nonmusical subcategories of the CRASS across 10 sessions.44 Subject C 30 I 1 2 3 4 5 6 7 6 9 10 Sessions Figure 4 Communicative Responses/Acts ofSubjects C across 10 sessions Study.01 level (T =0). Statistical analyses were applied to the subjects’ first and last session scores in all of the subcategories of the CRASS. The Wilcoxon Matched-Pairs . thus supporting the original analysis completed Figure 13 shows group mean scores in each of the four musical subcategories of the CRASS across 10 sessions. Significance was achieved at the .

01 level between first session scores and last session scores for tempo (T = 0). speech production (T = 0). A Spearman Rank Correlation Coefficient was calculated be- . pitch (T = 0). and communicative-interactive (T = 0).vol.05 level were found between first session scores and last session scores for communicative intent (T = 2. structure/form (T = 0). NO.5). XXXI. 1994 45 Subject D 10 Sessions Figure 5. Signed-Ranks Test indicated significant differences at the . rhythm (T = 0). Significant differences at the .1. Communicative Responses/Acts of Subject D across 10 Sessions. spring.

nonmusical speech production be haviors also increased. These results indicate that.05 level (t = 2.532). as musical vocal behaviors increased. Table 1 shows each subject’s total point gain in both of these categories. The Behavior Change Survey was completed by 11 parents. . The coefficient corrected for ties was .Subject E Figure 6 Communicative Responses/Acts of Subjects Eacross 10 Sessions tween the musical vocal behavior gains and the nonmusical speech production gains as recorded on the CRASS.645. which was significant at the .

8). XXXI. teachers. and 2 speech therapists. and speech therapists. and finally the speech therapists (M = 4. . 4 teachers. Overall. Table 2 shows the means for each of the three categories as answered by the parents. followed by the teachers (M = 4. and speech therapists.2). Changes were seen in all three categories by parents.7). Communicative Responses/Acts of Subject F across 8 Sessions. Most of the means fell between 4.Vol. which indicated no change. 1. and 5. Thirty-three surveys were distributed and 29 were returned (58% return rate). the parents gave the highest ratings (M = 4. which indicated a slight change. No. 1994 47 Subject F Responses 1 2 3 4 5 6 7 8 Sessions FIGURE 7. teachers. Spring.

9). The Spearman Rank Correlation Coefficient was used to determine whether there were any correlations between (a) gains in CRASS scores and parent Behavior Change Survey ratings. Both the communication and the social/emotional categories received a mean of 4.48 Subject G Responses 70 60 1 Sessions FIGURE 8. Communicative Responses/Acts of Subject G across 10 Sessions. (b) gains in CRASS scores and teacher Behavior Change Survey . The highest rankings were given in the musical category (M = 4.5.

01 level (t = 3. A significant correlation was found between the gains in CRASS scores and the parent ratings. ratings. No. The rho corrected for ties for gains in CRASS scores and teacher ratings was . FIGURE 9.217 and did not reach significance. and (c) gains in CRASS scores and speech therapist Behavior Change Survey ratings.773. 1. which obtained significance at the . Spring. The rho was . Table 3 shows each subject’s gain in CRASS scores and his/ her total ratings obtained from the Behavior Change Survey.Vol. 1994 49 Subject H I*+ Responses 70 7 I Communicative Responses/Acts of Subject H Across 10 Sessions. The Spearman Rank Correlation .658). XXX/.

387 and did not obtain significance. Coefficient. corrected for ties for gains in CRASS scores and speech therapist ratings. Discussion Results of this study suggest that improvisational music therapy is effective in eliciting and increasing communicative behaviors in autistic children within a musical setting. These re- . was .50 Subject I 10 hi 0 1 Sessions Figure 10 Communicative Responses/Acts ofSubject Iacross 10 Sessions.

1973). Jacross 9 Sessions sults support numerous case studies and clinical experiences which suggest the effectiveness of improvisational music therapy (Alvin & Warwick. 1968a. Nordoff & Robbins. XXXI. . This study differs from current research available in the area of improvisational music therapy and communicativeness in autistic children in that objective methods of control. observation. Hollander & Juhrs. 1992. Spring. Saperston. 1994 123458789 Sessions Figure 11 Communicative Responses/Acts of Subject.Vol. 1. and data reporting were applied. No. 1974. 1977. 1964. 1971.

Subject K 1. Results of this study show that autistic children can make gains in communication when participating in a low-structured intervention. but also allows for successful experiences. in which structured approaches are frequently recommended. These findings are contradictory to current literature and research.3’ Responses Figure 12 Communications Responses/Acts of Subject K across 10 Sessions. Do autistic children need more opportunities to experience spontaneity and creativity successfully? The improvisational approach not only allows for spontaneity and flexibility. Within .

the group as a whole used . and pitch). 1. structure/form. and Pitch across 10 this spontaneity. Significant differences were noted between the number of each of the four musical communicative modalities used by the autistic children in their first sessions and the number used in their last sessions. Sessions. No. Rhythm. In comparing these four modalities (tempo. music provides for sufficient predictability to give the child the amount of support he/she needs. XXXI. 1994 FIGURE 13. Spring.Vol. Structure/Form. Group Mean Scoresin Tempo. rhythm.

9). Also. Communicative Intent across 10 Sessions.6). Group Mean Scores in Speech Production. and tempo most frequently in both the first and the last sessions. in order of group mean decreasing point gains. The other three modalities. One interpretation of these data concerns the rhythmic repetitive behaviors characteristic of autistic children. the largest point gain from the first to the last session was noted in tempo for the group as a whole (M = 9. and form (M = 4. rhythm (M = 5).54 Journal of Music Therapy Nonmusical Subcategories of CRASS 10 6 12 3 4 5 6 7 8 9 10 Sessions Figure 14.7). Colman . Cummunicative-interactive. were pitch (M = 7.

Spring.2 Social/Emotional 4. 1. XXXI.2 .4 Behaviors 4. and beating/vocalizing and matching tempo variations.Vol. Thaut (1980) suggested the possibility of rhythm being absorbed on a physiological level and bypassing the cognitive deficits of autistic children. Because of the fundamentally rhythmic behaviors of autistic children.1 Overall 4. tempo may initially be one communicative modality in which autistic children can immediately experience success.2 4.5 4. No. His definition of rhythm encompassed both the tempo and the rhythmic modalities measured in this study. matching the experimenter’s tempo.2 Speech 2 3 0 2 2 1 3 1 7 5 1 2.7 Musical 5. and Speech Therapists Communicative Behaviors 4. The modality of tempo consisted of beating/vocalizing in a steady tempo. 1994 55 TAble 1 CRASS Musical Gains A Vocal 23 Vocal Behavior Gains and Nonmusical Subjects F G 8 19 Speech Production B 26 c 9 D 32 E 21 H 12 I 36 J 11 K 3 Means 18. This could provide one possible explanation for the high levels of communicativeness found in the tempo mo- Table 2 Mean Scores for Behavior Change Survey Categories as Rated by Parents Teachers. CRASS = Checklist of Communicative Responses/Acts Score Sheet.5 Note.7 4. and his colleagues (1976) assert that there is a stability in the frequency at which repetitive behaviors occur.

This could have created a sense of awareness. However. using their levels of intensity. CRASS = Checklist of Communicative dash indicates no score was available.56 Journal of Music Therapy Table 3 CRASS Gain Scores and Total Behavior Change Survey Ratings Work-up for the Spearman Rank Correlation Coefficient Means 32. In the modality of pitch. as noted subsequently. subjects demonstrated minimal increases in the rhythm modality. A dality. sense of control over their environment.8 62. however. It is significant that all 11 subjects made gains in this modality. their rhythms. All of the items in this modality were vocal responses.6 55. Condon (1976) reported that listeners move in exact synchronous relationships with speakers. One could posit that this synchrony facilitated communicative interaction through the music. Another interpretation of the increased amount of communicativeness found in the tempo modality concerns interactional synchrony. the music was synchronized with the children’s repetitive movements and vocalizations. and a new means of cornmunication. . gains ranging from 3 to 15 points were noted. Condon found that this synchrony is distorted (1975). and their tempi. In researching autistic children. The subjects in the present study were able to synchronize their drum beating with the ongoing music to varying degrees. Also. Responses/Acts Score Sheet.1 Note.9 60.

however. However. Perhaps there is a connection between the cognitive deficiencies found in autistic children and the modalities of rhythm and structure/form. However. parents. which indicates that. Parents and teachers reported more changes than did speech therapists in all three categories. A significant correlation was found between the subjects’ CRASS gains and the parents’ total Behavioral Change Survey ratings. Spring. This could be due to the limited amount of time the speech therapists see the subjects as compared to the teachers and parents. the gains were smaller than with the previous two modalities discussed. p < . teachers. Results of the Behavior Change Survey indicated change in subjects’ behaviors. Further research is needed to examine this question. This could have been influenced by knowledge of the subjects’ participation in the music therapy research study. the significant relationship found between increases in musical vocal skills and increases in speech production skills leads to the question as to whether there is a cause-andeffect relationship.05) indicates that. the change was minimal. Both modalities demand more cognitive involvement as compared to tempo. 1. this could be one possible explanation for the observed increases in musical vocal behaviors. as musical vocal behaviors increased.Vol. It is possible that. No. 1994 57 Overall gains were also noted in rhythm and structure/form. nonmusical speech production behaviors also increased on the average.645. Also. It has been stated that communication through music bypasses the speech and language barriers of autistic people. parents of subjects who demonstrated the most CRASS gains rated their children . due to this knowledge. The significant correlation coefficient obtained between the musical vocal behavior gains and the nonmusical speech production gains (rs = . and speech therapists became increasingly aware of the subjects’ attraction to musical stimuli and demonstration of musical behaviors.XXX/. on the average. the placebo effect must be taken into consideration when interpreting these data. The musical category was the highest rated category overall. It is possible that the changes observed in the subjects’ behaviors could have been attributed to changes in the parents’ and teachers’ attitudes and expectations of the subjects since they were aware of the purpose of this study.

. should be controlled in future studies. One possible reason for these differences might be that teachers and speech therapists use a more structured setting than do parents. Also. One change in the CRASS is also recommended for future research. a male:female ratio which is proportional to the actual ratio found in autism. would help increase the generalizability of the results. Other studies could focus on pragmatic aspects of autistic children’s communication in an improvisational music therapy setting. a larger number of subjects would increase the validity of the study. Further experimentation might increase understanding of the communication deficits of autistic children. First.4 to 4. An increase in the number of items in the nonmusical category would provide a more comprehensive look at the communicative behaviors of autistic children in music settings and would balance the nonmusical and musical sections of this measurement device. The question of possible generalization or transfer of learning from one setting to another emerges from this finding. 1989). Within the structured environment. Another suggestion would be to increase the total number of sessions for each subject. which would allow for more sessions during the reversal phase. some changes should be considered.58 Journal of Music Therapy higher on the Behavior Change Survey than did the other parents. Future research studies in improvisational music therapy could be designed to study both the effects of specific techniques within improvisational music therapy and autistic children’s specific responses in the various musical communicative modalities. The teachers’ and speech therapists’ total ratings were not significantly correlated with subjects’ CRASS gains. This increased knowledge could facilitate the development of intervention programs in which autistic children could express themselves and experience the joys of communication. which ranges from 1. including the various settings of the study and the decrease in eye contact and increase in materials during reversal. Uncontrolled factors.8:1 (Gillberg. opportunities for subjects to demonstrate spontaneity and use new skills may be limited. If this study is replicated. identifying and comparing the specific communicative functions in both singing and speaking contexts.

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and behavior analysis of videotaped students’ performances.92. scores of the State Anxiety scale of the State-Trait Anxiety inventory (STAI). df = 1.0001) and STAI scores (F = 23. OR 97301. df = 1. and behavioral components of performance anxiety and performance quality of music students. Salem. Performing arts medicine. . behavior. STAI scores.0001) between non-jury and jury conditions. started receiving public attention in the last decade when research began to show that performers. Music Department Willamette University. p = . and (b) to examine how open and double-blind jury conditions affect physiological. Please address correspondence regarding this article to Dr. as a new medical specialty. p = . 59) = . Results showed significant increases in heart rate (F = 130. Further analysis showed no association among variables suggesting that there may be different types of performance anxiety.01. Melissa Brokons. performance quality ratings by judges. and performance quality due to open and blind jury conditions. p = .Effects of Performing Conditions on Music Performance Anxiety and Performance Quality’ Melissa Brotons Willamette University The purpose of this study wee twofold: (a) To determine if there is a difference in physiological and psychological responses that measure performance anxiety between nonjury and jury conditions. but no significant differences (F (4. Dependent variables were heart rate. Sixty-four college music students in each of five instrumental areas and one vocal area participatedin this study.444) occurred in heart rate. among them musicians of all levels of training and expertise.95. probably suffer from a variety This paper is a report of the author’s dissertation research completed at The University of Oregon. The experiment was a pretestposttest control group design with matching. psychological.

numb fingers. sweating. 1989. irritability. upset stomach. dizziness. Psychological/emotional conditions. Excessive stress. such as loss of confidence. such as lips moistening. 1988.64 Journal ofMusic Therapy of physical. Cognitive problems. and Robert Schumann are examples of great musicians affected by these types of illnesses. nausea. 1990). Ely (1991) and Salmon (1991) identified four different manifestations of performance anxiety: 1. debilitating problem which functionally impairs a large number of musicians. Some degree of stress and tension (adaptive anxiety) is experienced by most musicians. however. Beethoven. Stage fright appears to have different origins and meanings depending on what components are emphasized and how they . 3. and inability to infuse life and color into the music are examples of disturbing mental processes that take place under stage fright (Hingley. Physiological changes that take place within the body might include one or more of these characteristic traits: increased heart rate. and deadpan face are representative behaviors exhibited by performers with stage fright. A review of Arts Medicine literature indicates that performance anxiety is one of the most often cited problems that musicians suffer (Goode & Knight. is a serious. 1989). Pearson. clammy hands. and generalized panic are the most common symptoms experienced at this level. knees and hands trembling. these problems become so severe that professional musicians must terminate their performing careers (Lockwood. memory lapses. also known as stage fright. lack of concentration because of the thoughts and worries about the performance situation. 2. dry mouth. Performance anxiety. Behavioral changes. psychological. 1991). shaking. 1985). Plaut. 4. In some cases. such anxiety can discourage performers from further study of music (James. and diarrhea. 1990). 1989). Paganini. Wolfe. shortness of breath. shoulder lifting. fear of failure. and some stress appears to be necessary to reach peak performances (Caldwell. such as exaggerated feelings of apprehension. 1990. arm and neck stiffness. becomes debilitating and leads to inefficient use of musical skills. and occupational stress problems (Lederman. When sufficiently adverse during performance. headache.

even paranoid. 1990. XXXI. Brandfonbrener (1990) stated that “performance anxiety is simply a manifestation of psychological problems and cannot be discussed appropriately in isolation. 1994 65 are interpreted according to the different psychological theories. No. type of instrument and repertoire typically associated with it. Furthermore.. 1990. Several treatment modalities that ameliorate negative consequences of performance anxiety have been investigated and are described in the literature. 1991). and nausea (Dubovsky. and unconscious conflicts that are developed during childhood and that become ignited in particular circumstances such as anticipating or giving a concert (Nagel. 1. 1986). & Strommen. 1990. 1). Goldman. and level of preparation (Ely.Vol. Pharmacological forms of treatment. 1973. Plaut. “I must be approved by the audience in order to feel good.” These persistent thoughts psychologically enfeeble self-confidence and negate hours of preparation (Nagel. Several studies have been conducted which support this theory (Lehrer. Each symptom of every person must be evaluated within the context of that individual’s psychological make-up” (p. Tobacyk & Downs. hyperventilation. traits. Cognitive-behavioral theory attributes performance anxiety to negative thoughts and self-statements such as. Weisblatt. 1985). specifically beta-blockers. have been prescribed over the years mainly to reduce the adverse physiological symptoms of performance anxiety such as palpitations. Other variables not directly linked to any psychological theory are mentioned in the literature since they appear to have a relationship with performance anxiety. For instance. 1990. Nagel. The results of studies examining the effect of beta-blockers to reduce . Their results indicate that the degree of performance anxiety and its effects during performance are the result of the frequency and intensity of negative. Psychoanalytic theory views performance anxiety as a cluster of attitudes. tremor. types of thoughts before performance. age. Spring. 1990). Hingley. years of experience. 1986). physiological theory has catered on the problem of unpredictable motor coordination as a result of the release of excessive adrenaline in an anxious situation (Havas. These variables are: types of musicians and jobs. 1990).

1985). The effect of different treatment interventions to ameliorate this problem has also been investigated with professional musicians. imagery (Dunkel. Other techniques mentioned as effective for particular individuals are movement/physical exercise (Ristad. Trusheim. and tempo. 1991). there are potential risks in taking beta-blockers over long periods of time (Nies. 1976. and physiological components of performance anxiety. 1982. few studies have been conducted with music students or have examined performance situations other than concerts. dynamic control. Individual and group music therapy interventions. Although this type of medication has been shown to be safe for many musicians. have also been shown to have a positive effect in reducing the performance anxiety of professional musicians (Mantello. It is interesting to note that up to the present time the focus of interest among researchers has been on professional musicians and their performance situations: concerts and recitals. Rider. 1982). 1987). and biofeedback have proven to be very successful in reducing physiological and cognitive symptoms of stage fright while improving performance (Appel. Shepherd. Other studies have focused on examining the effect of different psychological treatments to reduce cognitive. 1975). alone and in combination with other behavioral techniques. 1982) and small doses are administered (Gates. and the combination of relaxation training with hypnosis (Plott. Saegert. the results of a study conducted by Lehrer. and Greenfield (1987) show that beta-blockers can enhance different dimensions of performance such as intonation. rhythm. Coons. & Kantor. Wilson. 1988. However. bow control. Mansberger. Furthermore. especially among professional musicians. Behavioral techniques such as systematic desensitization. behavioral. Wardle. This appears to be especially true when the medication is taken immediately before or at the beginning of a performance (Nettel. 1989. 1986). cognitive/attentional intervention. 1990. Kostis. accuracy. 1990). & Hearned. & Vorkauf. . Rosen. memory.1 66 Journal of Music Therapy performance anxiety show that beta-blockers are effective as one means of temporarily controlling the negative somatic symptoms of performance anxiety (Nub&. Kaser. 1987). planning the performance well in advance (Caldwell. Johnson. Fogle. evenness of vibrato. 1990).

However. Juries are periodic evaluations of performance that determine grading and advancement. brass. In a double-blind jury. XXX/. and specifically how these two types of juries affect performance anxiety. 1. This type of jury is widely used in colleges and universities as an audition procedure for acceptance into music programs and competitions for scholarships. chairs. and behavioral components of performance anxiety and performance quality of music students. piano. and solo parts. 1982). However. 1994 67 Researchers consistently have found that performance anxiety occurs because performers feel constantly evaluated and compared against a perfect standard (Gabbard. In an open jury. The purpose of this study was twofold: (a) To determine if there is a difference in physiological and psychological responses that measure performance anxiety between non-jury and jury conditions.Vol. performances that are entirely aimed at evaluation are exams or juries that are commonly practiced throughout the musical world. Limited objective information is available about the effect of stage fright on jury performance. and mostly in job auditions. 1980). Method Subjects Subjects for this study were 64 music students representing five instrumental areas (woodwinds. Sometimes audio recordings are used for evaluation purposes instead of live performances for this type of jury situation. and . Two types of juries commonly used in academic and professional settings are open and double-blind juries. One of the purposes of concerts is to bring enjoyment to an audience. No. concerts and recitals have other aims besides being technically perfect. the performer plays in front of judges. musicians perform behind a screen so that neither they nor the judges know each others’ identities. Only one study was found that compared the effect of two simulated jury conditions on perceived anxiety and performance quality (Hamann. strings. and (b) to examine how open and double-blind jury conditions affect physiological. Spring. This modality of jury is also used in colleges and universities for admission purposes and/or to grant scholarships. and both parties (performers and judges) know each other. psychological.

1991). “During practice time The post-jury . and 18 of both forms were scored in reverse order. Apparatus. Subjects’ behavior was observed on a researcher-developed behavior observation form.. The pre-jury form included the phrase. Campbell. Items 3. “During the jury . This piece of equipment had been used in previous studies and had shown to be suitable specifically to measure musicians’ heart rates while in a performing situation (LeBlanc. SD = 8.. (d) dynamics. (f) expressiveness/musicianship. Performance quality was measured on a researcher-designed observation form that included eight items that were rated on a five-point rating scale (“1” being excellent and “5” fair). & Jacobs. (c) technical competency.. (b) rhythmic accuracy. Their age range was 18-64 years (M = 24. Seven of these items referred to specific characteristics of music performance: (a) intonation. 1980). (b) body. and the second at the end which asked the subjects to evaluate how well they had played for the jury. Subjects were observed from the time they started playing until the end of their performance.” before the 20 items of the questionnaire. 12. The eighth was a total performance rating in which a global assessment of the students’ performance was given. & Codding. Gorsuch. and (g) tone quality. 4.. 13.. 9. Form Y-1) (Spielberger. (e) instrument behavior. Facilities. (c) arms and hands.”before the 20 items of the questionnaire. and (f) vocalizations. The procedure used was observation for 20 seconds followed . Vagg. There were 32 males and 32 females in the sample.02. form had two items added. (e) phrasing. 14.66 Journal of Music Therapy percussion) and one vocal area enrolled in undergraduate and graduate music programs at a large state university. and Materials All testing was done in the School of Music of a large state university. Heart rate was measured by using the Polar Vantage XL heart rate monitor model #45900. Lushene. It included a total of 23 behavioral indicators of nervousness in the following six categories: (a) feet and legs. . 7. (d) face. The first one was. 6. 17. Subject selection criteria were based on each subject’s willingness to participate and their commitment to pass juries during the school year.24). Perceived anxiety was assessed with a modified version of the State scale of the State-Trait Anxiety Inventory (STAI.

1994 69 by a lo-second interval during which the observer(s) recorded the observations. After the last pretest period.Vol. subjects (N = 32) performed a 5. For the open jury condition. Prior to beginning the jury. The Pearson product-moment correlation as a measure of interobserver reliability was calculated to be . Spring. The pretest was the studio practice and the posttest the jury 10-minute composition during a normal jury situation. starting 2 minutes before their performance and lasting until the end of the 13-minute periods while practicing alone in a studio in order to obtain a heart rate baseline for subjects in a relaxed performing situation. During these three intervals. Subjects were matched according to age. This questionnaire was filled out after each practice period.XXXI. The second pretest was a modified version of the STAI to get a score on how anxious they felt during practice (non-jury) time (Spielberger et al. at 5-second intervals.99. students also had the opportunity to learn how to wear the heart rate monitor properly and become accustomed to it while performing. These jury performances were videotaped in order to do a post-hoc analysis . gender. subjects were told the condition to which they had been assigned to perform their jury (open or double blind). Two pretests were given to the music students. Design and Procedure The experimental design used in this study was a pretestposttest control-group design with matched groups (one receiving an open jury condition and the other a double-blind condition). the subjects completed a short prejury interview that included three questions: (a) Normally how do you feel in a jury situation? (b) How do you feel about the open/double-blind jury condition? (c) How prepared do you feel for this jury? They were rated on a four-point rating scale (“I” being very relaxed/prepared and “4” very nervous/not prepared).. During the jury. No. years of formal training. their heart rate was measured. Subjects’ heart rates were measured at 5-second intervals during three 7. Independent observations were obtained for 58% of the cases selected randomly. 1. 1980). and instrument. and then were randomly assigned to one of the two jury conditions (see Table 1 for groups’ equivalency).

p: piano. F: female. 1t(31)= 1. In addition to having in-house judges. YFT: years of formal training.50. mostly for discussion purposes.30. Perc: percussion: s: strings. V: voice: of performance behavior.051.: instrument. 9 (28%) F: 17 w: 11(34%) B: 6 (19%) P: 1(3%) Perc: 2 (6%) s: 3 (9%) F: 15 w: B: P: Perc: s: 7 (22%) 6 (19%) 2 (6%) 3 (9%) 5 (16%) W: woodwinds. 2t(31) = 0. subjects filled out another modified version of the STAI in order to get a measure of how anxious they felt during their jury. and they were informed that their performances also would be rated by unknown external judges. Interrater reliability for each questionnaire item ranged from . B: brass.09 Blind Gender M YFT M: 17 8. the subjects (N = 32) completed the same pretests and posttests as the subjects in the open condition. For the double-blind jury condition. Neither the subjects nor the judges had any information about each other. The specific questions were: (a) How do you feel about the jury you just performed? (b) Were you nervous? (c) What aspects of the jury made you feel nervous? (d) Had you ever performed for a double-blind/open condition before? (e) (for subjects in the double-blind condition only) Did the blind condition have an effect on your nervousness? (f) Did the heart rate monitor bother you? (g) Did the video-camera bother you? In addition. .28 to . Immediately after their performance. Inst.525. M: male.70 Journal of Music Therapy Table 1 Subject Demographics M Age 22. The external judges evaluated the subjects’ performances using the same type of performance quality form that the in-house judges used. and they answered the questions of a post-jury interview. two judges (own teacher of applied instrument and another teacher in the area) rated the quality of each student’s performance on a performance quality form. 9(28%) M Age 25. p = .60. the subjects’ performances were audio-recorded.33 v: Inst.73 v: Inst.94 Open Gender M YFT M: 15 7. p = .

behavior . 1. XXX/. mean of behaviors displayed during jury playing. homogeneity of variance-covariance matrices and multicollinearity were satisfactory.Vol.95. STAI difference scores. p = .92 (SD = 9. and a total score was obtained from the STAI questionnaire completed after the jury performance. df = 1. No.92. These results indicate that juries were perceived as more stressful than practice time by these music students. behavior. STAI scores. STAI scores increased from a mean of 35.70) during non-jury to 45. and performance quality existed between jury conditions. A one-way ANOVA was calculated for each of these two dependent variables.68 (SD = 17. 59) = .97 (SD = 13. p = . To determine if a difference in heart rate. and performance quality mean. Heart rate increased from a mean of 98. Test anxiety appears to affect physiological (also referred as emotionality) and psychological (cognitive. Wilkinson. Results revealed a significant difference in heart rate (F = 130.26) during jury condition.01. according to the results of this study. particularly in the sense that the context of test-taking is similar to that of a jury performance. the three baseline periods were first averaged to obtain a single baseline score for heart rate and STAI scores for each of the 64 subjects. The same can be stated about musical performance anxiety. linearity. Results of this study resemble findings from studies in the area of test anxiety. difference scores between STAI prejury and post-jury scores. 1990). With the use of Wilk’s criterion. p = . 1994 Results 71 To determine if there was a difference in subjects’ heart rates and STAI scores between non-jury and jury conditions. df = 1. data were analyzed using multivariate analysis of variance or MANOVA (MLGH module of the SYSTAT statistical package. 1973). evaluative) aspects of human response (Morris & Liebert. Data points for analysis included: percentage of heart rate change between nonjury and jury conditions.90) during jury condition. This result indicates that there were no significant differences in heart rate means. Evaluative results on the assumptions of normality. Also. a mean was calculated from the heart rate sample taken during jury performance.44]. Spring.0001) and STAI scores (F = 23.79 (SD = 13.85) during non-jury to 130.0001) between non-jury and jury conditions. the combined dependent variables were not significantly affected by jury condition [F (4.

. No significant differences were found in post-heart rate and post-jury STAI scroesdue to jury condition when the pretests were used as covariates. data from this study were also analyzed using Univariate analysis of Covariance.64 . respectively). Wind players used their faces to 2Because of the present controversy in using difference scores in statistical analysis. remained quite low.64 .004 1 1 1 1 88. The STAI change revealed higher perceived anxiety responses from subjects in the double-blind condition.62 . and performance quality ratings between open and double-blind jury groups.2 As seen in Table 2. the dependent variable that was closest to reaching significance was STAI change.43 . The category of behavioral responses most prevalent for each instrument seemed to be largely determined by the characteristics of the instrument as to what part of the body was free to move (see Table 4).32 . The results were virtually the same asthe MANOVAS. however.32 . Table 3 presents the means and standard deviations of the four dependent variables for both jury conditions.72 Table 2 Univariate F Tests Comparing Four Dependent Variables Between two Jury conditions Heart Rate Change STAI Change Behavior Perf.03 500.004 . indicating that this variable was the one that discriminated the most between the two jury conditions. It is clear that there was an increase from practice time to jury time in heart rate and STAI scores in both groups despite the high variability among subjects.01 . For instance. These results were further confirmed by the results of the pre-jury interviews. Quality 88.53 . pianists as well as some brass and woodwind players would play seated. indicating the low presence of nervous behaviors and high performance quality.03 500. while the rest were standing. More people in the double-blind than in the open jury condition felt nervous about their jury condition (45% and 19%.21 2. The means of behaviors and performance quality in both groups.65 .92 means.12 .

the higher the scores in performance quality (indicating poorer performance quality). Body: swaying during playing.36 7. 1.75 2.26 22.12 . indicating that the higher the STAI scores. and touching the music stand before performance when not playing were most frequently observed. 4. were the most typical during performance.47 15. Pooled within-cell correlations among the four dependent variables across both jury conditions indicate low relationship and independence (see Table 5).Vol. 2. Instrument behavior: Adjusting. No.51 HR: Heart Rate Change: STAI: State Scale of the State-Trait Anxiety Inventory Change: PQ: Performance Quality.61 2. 5. inspecting the instrument. Feet and legs: shifting and tapping during playing and shuffling and pacing during measures of rest or in between movements of the piece. and the percentage of behaviors observed in their faces (bucal muscles) was very small (4% for woodwinds and 9% for brass). This finding correlates with others in the area of test anxiety that showed that emotionality (physiological component) at the .19 . The specific behaviors frequently observed in each category were the following: 1. Touching the body.29 13.33 .69 2. and some lips moistening and jaw movements occurred during measures of rest and in between movements. like drying one’s hands or removing hair from the face were most common during nonmusic intervals. and some big breaths during music rests or in between movements.07 2. such as arms flapping to the rhythm of the music. play their instruments. Spring. XXXI. 3.76 31. Face: Head moving was the most prevalent action of the face during performance. 1994 73 TABLE 3 Means and Standard Conditions Deviations for Dependent Variables Under Two Jury M SD 34. manipulating. Arms and hands: Arm and hand movements.67 12. The highest correlation obtained was between State anxiety and performance quality. Vocalization: No behaviors in this category were observed.13 . 6.92 18.

psychological. Discussion The results of this study clearly demonstrated that performance anxiety affected some physiological and psychological dimensions of music performance similar to the results of other studies (Ely. Gabbard. or behavioral). despite this significant increase in heart rate from studio . and that the cognitive component (worry) may or may not be accompanied by the physiological one (Morris. it is impossible to do any comparisons. as well as (b) the high variability in heart rate and STAI scores. 1989) that performance anxiety affects musicians of all levels of training and expertise. 1991. The jury heart rate mean appears to be very high in this study. This speculation is supported by the (a) variety of answers to Question 3 of the post-jury interview. which asked subjects what aspects of the jury made them nervous. Face BehaviorVocal N Woodwinds Brass Piano Instrument Voice Feet &legs 17% 37% 35% 52% 4. In the present study. students with a variety of years of formal training and jury experience responded similarly with increased heart rates and more anxious feelings during open and double-blind juries than in practice conditions. These performance anxieties may be aroused and maintained by different aspects of stressful situations.74 TABLE 4 Journal of Music Therapy Percentage of Behaviors According to Families of Instruments Inst. 1980). Davis. 1981). 1976). but because of a dearth of research that includes heart rate as a measure of performance anxiety. Salmon.5% 3% Body Hands 30% 20% 37% 16% 20% 22% 23% 19% 6% 9% 4% 24% 37% 4% Percussion strings 9% 51% 26% 19% 0% 6% 18% 3% 2% 5% 0% 0% 0% 0% 0% 1% 18 18 12 3 5 6 time of a test was not related to examination performance (Smith & Morris. These findings also confirm the findings of previous investigations (Salmon. & Hutchings. & Wright. It is important to mention that. 1991. Schrodt. This finding suggests that there may be different types of performance anxiety depending on which component was prevalent in each individual (physiological.

This finding is further confirmed by the results of the interviews. Park. it did not seem to affect the students any differently in this study. Responses to the post-jury interview. No. post-jury interviews concerning the double-blind condition may also be explained by the fact that playing an instrument or singing involves multiple tasks. Curcher. Fingret. 1. such as. Wright. Although the intention of informing the students in the double-blind condition that they would be rated by unknown judges was to increase subjects’ apprehension.099 PQ 1 -. or some psychological variables involved in performing music.069 . Sparrow. Spring. Keegan. physiological (heart rate).085 . 1994 75 TABLE 5 Pooled within-Cell Correlations Two Jury Conditions Among Four Dependent variables Across Heart Rate Change STAI Change Behavior 1 . behavior. This may he due to the exercise involved in playing an instrument or singing. The decrease in percentage of nervous reports from pre.033 1 practice to jury condition.Vol. The second major finding of this study was that. & Fox. XXXI. after the jury the students acknowledged that the effect of the blind condition was even less stressful than at the time of performance (13%).097 -. This finding confirms other findings that musicians have higher heart rates than other more sedentary individuals (Mulcahy. Although a moderate percentage of students in the double-blind condition reported feeling nervous about the blind condition in the pre-jury interview (45%).e. psychological (state anxiety).” were common among students in the blind condition. when the four constituents of musical performance anxiety. the majority of subjects in this study started with an accelerated heart rate during pre-jury periods.. This may enhance or hinder the problem of stage fright by . I completely forgot about it. “Once I got up there. 1990).219 1 -. there was no significant difference in response that could be attributed to type of jury condition. and performance quality were compared according to the jury situation.

An explanation for this finding is suggested by Middlestadt (1990). Thus. Wolfe. quality of performance was not differentially affected by the two jury conditions. Due to preoccupation with instrumental/vocal technique.76 Journal of Music Therapy feeling more overwhelmed or becoming so involved in the playing/singing that any external variables are forgotten. neither the behavior nor the quality of the performance is affected. Schrodt. who claimed that peak anxiety is reached before the performance. and are not necessarily related to nervousness. and Wright (1989). The means of this variable show that the quality of the performance in both groups was quite high. As far as behaviors observed during performance are concerned. subjects may have been less bothered by performance pressures. it is not possible to determine whether behavior and performance quality on stage were better or worse than in the practice room. That is. Poise and charisma on stage are important attributes in becoming a successful performer. 1990. This is especially true for singers and becomes part of their evaluation. The other variable that needs some comment is performance quality. Because this study did not compare performance quality or behavior between non-jury and jury conditions. The means of the four dependent variables for both jury conditions indicate that the two variables whose means differ the most from practice time to jury time (heart rate and perceived anxiety) are the ones that were measured with two standardized instruments (heart rate monitor and State scale of the State-Trait Anxiety Inventory) as opposed to specifically constructed observation forms. Plaut. except for instrument behaviors and touching the body. most behaviors observed would be considered normal in a performance situation. the amount of stress experienced . Those behaviors are part of musical interpretation and expressivity. 1989). This suggests that the standardized instruments may be more sensitive in discriminating small changes in anxiety. and Wine (1982). It would be peculiar and unusual to have musicians totally still while performing on stage. Salmon. but that the problem is alleviated once the musician starts playing. Thus. Another explanation may be that the type of stress experienced by these subjects at the time of their juries was adaptive as opposed to debilitating (Caldwell. 1990.

and they probably respond differently to the situation.Vol. In the musical world there is a classic quote. For instance. in order to gather more information on how these variables are affected by stressful performance situations. “Your peers are your worst critics. XXXI. Undoubtedly. Because so many music therapy programs are located in schools of music or music departments of colleges and universities. The field of music therapy has a considerable body of research on the use of music to reduce stress and anxiety (Hanser. It would be a big step forward in the field of music performance anxiety if future studies could determine the point at which anxiety becomes detrimental to the performer. Rider. & Kantor. thus causing additional worries (Salmon. 1994 77 by these students was facilitating as opposed to distracting so that their performances were enhanced instead of hindered. Montello. Further research is warranted. Other fears stated were: messing up by not remembering words and/or music (worry component). Coons.” and this clearly was a concern for many students. to determine the ideal therapeutic interven- . changes in acoustical and spatial factors may alter the manner in which sounds are usually perceived. not being able to control the shaking and the breathing (physiological component). feelings of insecurity by doubting the quality of the performance (worry). These two categories are a clear representation of fear of being evaluated. and being in a different room (worry). NO. 1987). 1990. Future studies might also observe and record performance quality and behavioral movement in the practice room. 1. 1985). Spring. 1991). Furthermore. The fact that the four variables are highly independent and that there was high variability among subjects in heart rate and STAI scores suggests that people’s anxiety may be triggered by different aspects of performance. 1976. however. Do the findings of this study have any practical implications for helping music students with performance anxiety? The resuits indicate that juries are clearly sources of stress for music students. getting too excited (worry). having judges and peers in the room was an aspect that concerned a high percentage of students. this is a population easily accessible for treatment and investigation by music therapists. a few studies have already applied some of these stress reduction techniques with anxious musicians (Appel.

NY: Pendragon Press. 3-10. performers with different anxiety modes can be matched with the most appropriate treatment interventions. S. D. 51(Suppl. It would be helpful to start developing standardized scales that can clearly discriminate and identify which of the four factors of performance anxiety is most prevalent in each performer and the order in which they develop. Stop performance anxiety! MUSICEducators Journal. 4). The performerprepares. 2-16. 35-39. anxiety. As a medical doctor pointed out.78 Journal of Music Therapy tion that promotes relaxation and yet allows concentration and arousal to be maintained for effective musical performance. Medical Problem Journalof Music Therapy. By studying individual differences. Dunkel S. Brandfonbrener. (1990). S. Generalized anxiety disorder: New concepts and psychopharmacological therapies. and Practice. Music teachers. 1991. G. (1991). R. 13. Fogle. 79(2). It appears that the four components of performance anxiety manifest themselves quite independently. Dubovsky. C. The audition process: Anxiety management and coping strategies. could individualize and start this process with students in order to know how best to help each student. p. 1).TX: PST Inc. (1990). Music therapists interested in this field should have a clear understanding of how the human body functions and responds to different stressful situations so that they can help their patients with anxiety problems. (1989). Research. . of Performing Artists. Modifying solo performance anxiety in adult pianists. 23-26. 368-375. L. iety. 5(1). Journal of Clinical Psychiatry. (1982). (1990). in the broadest sense. Ely. (1976). is highly dependent on our individual and collective creativity which is directly linked to the health of the creative among us-our artists and performing artists” (Lippin. Stuyvesant. Beta blockers in the treatment of performance Caldwell. Psychotherapy: Theory. A. it is erroneous to assume that every performer experiences anxiety in similar ways or for identical reasons. “the health of our world. D. Researchers interested in the area of musical performance anxiety must examine more fully individual differences in the experience of anxiety and the conditions that exacerbate anxiety. S. for example. M. References Appel. Dallas. 0. According to the results of this study. Toward effective treatment for music performance anx19(3).

(1991).. Johnson. Medicine and the performing arts. M. The use of group music therapy as a treatment for musical performance stress. & Codding. (University Microfilms. A.. Unpublished manuscript. Gates. 112. P. (1980). (1973). Music therapy and stress reduction research.. New Jersey Medicine. (1985). & Liebert. L. E. 221-227. 24. 5-9. A principal components assessment of performance anxiety among musicians. R. Medical Problems of Performing Artists. Coons. (1985). D.. E. retrieval. Mantello.. Effect of b blockade on singing performance. & Hearned. S. 1994 79 Gabbard. MI. Ltd. N. 8613172) James. Identification. M. (1985). Goldman. Lockwood. Unpublished master’s thesis. 84(1). E. P. Lehrer. J.. Journal of Research In Music Education. The Piano Quarterly. (1990).. p. C. (1981). International Arts Medicine Association. Transactions of the Medical Society of London. Lehrer. 1106A. (1988). Performance anxiety in music: A review of the literature. H. Suitability of a personal heart rate monitor for use in music research. A. 320. & Knight. Lederman. Saegert.. Middlestadt. 77-90. 4. Wilson. D. R. S. R.. on musicians‘ 320. Hamann. 47. L. N. The stage fright syndrome. D. Stage fright. R. LeBlanc. 5(1). 73.. 541-555. 193-206. Medical problems of symphony orchestra musicians: From counting people with problems ta evaluating interventions. S. S. XXXI. B. (1973). Spring. Journal of Music Therapy. D. 22.. Morris. 6(1). P. H. threat . and analysis of arts medicine literature. Effects of negative feedback. 49-57. P. G. Kalamazoo. S.. (1990). Campbell. W. state anxiety anxiety management and musical perfor- Mansberger. Dissertation Abstracts International. V. A.. (1990). (1989). Kostis. 12-18. J. A. J. Cognitive and emotional components of anxiety: Literature review and a revised worry-emotion&y scale. No. P. Medical Problems of Performing Artists. M. (1882). (1987). & Kantor.. Journal of Educational Psychology. Performing arts medicine. A. 30. A. Michigan State University. Treating stage fright in musicians: The use of beta blockers.. Havas. New England Journal of Medicine. Rosen... B. self-efficacy. Annals of Otology. K.Vol. (1989). L. M. (1988). 1. B. (1991). Hanser. O. and Laryngology. 570-574. & Hutchings. Medical Problems of Performing Artists. F. An assessment of anxiety in instrumental and vocal performances. J. D. 11-15. A. M. 3-7. & Greenfield. Update. Medical problems of musicians. October). The New England Journal training of Medicine. N. Morris. W. London: Bosworth & Co. Rhinology. Western Michigan University. (1991. 105. E.. 246-248. Shepherd. Hingley. J. No. L. Stage fright: Symptoms and causes. Goode. 27-33. 159-172. G. Interamerican Journal of Psychology. & Strommen. L. 94(1). Lippin. The effects of performance mance quality. Davis. 5(1). C.

(University Microfilms.. Effects of stimulative and sedative music on cognitive and emotional components of anxiety. Nube. Salmon. Medical Problems of Performing Artists. W. D. British Heart Journal.. A. Medical Problems of Performing Artists. 64. B.. Curcher. Psychological Reports. (1966). 55-59. H. D. 388-392. Salmon. An investigation of the hypnotic treatment of music performance anxiety.. (1990). (University Microfilms. 1. & Vorkauf. T. (1982). E.). & C. (1990). (1987). Pearson. (1990). Behavior modification by reciprocal inhibition of instrumental music performance anxiety. J. UT: Real People Press. 51. Performance anxiety and the performing musician: A fear of failure or a fear of success? Medical Problems of Performing Artists. No. C.. M. 655A.. Palo Alto. Park. J. J.. & Morris. A manual for the State-Trait Anxiety Inventory. 61-68. Psychotherapy of performance anxiety. (Eds. 87-01817) Rider.80 Journal ofMusic Therapy of shock. H. J. Greer. No. Spielberger. A. Nagel. Madsen. 27-32. down tempo. Psychosomatic Medicine. Mental imagery and musical performance: An inquiry into imagery use by eminent orchestral brass players in the United States. & Wright. S. . J. K. 461-469. 37-40 anxiety. Personal construct threat and irrational beliefs as cognitive predictors of increases in musical performance anxiety. M. Keegan. 4. Gorsuch. D. 6(2). 779-782. Smith. 40-43. (1982). Wright. M. Nettel. & Fox. Research in music behavior: Modifying music behavior in the classroom (pp. R. P. 4310B. Ristad. & Jacobs.. 5(1). P.. up tempo. Medical Problems of Performing Artists. Nies. & Downs. C. G. S. P.. Wardle. and level of trait anxiety on the arousal of two components of Mulcahy. 5(1). D. Tobacyk.. British Heart Journal. W. R. A temporal gradient of anxiety in a stressful performance context. A primer on performance anxiety for organists: Part 1. New York: Teachers College Press. Schrodt. 47. (1991). G. K. Journal of Consulting and Clinical Psychology. Clinical pharmacology of beta-adrenergic blockers. Dissertation Abstracts International. Music Therapy Perspectives. R. Circadian variation of heart rate is affected by environment: A study of continuous electrographic monitoring in members of a symphony orchestra. K. J. 58-63. A. (1990). 187-193. J. Lushene. C. Trusbeim. (1986). 49. A. (1976). A soprano on her head. J. 5(1). Dissertation Abstracts International. 64. A. H. R... 354. (1975). R. 44. Music therapy: Therapy for debilitated musicians. G. Sparrow. (1990). Beta-blockers: Effects on performing musicians. CA: Consulting Psychologists Press. M. A. Moab. Medical Problems of Performing Artists. A. Kaser. 321-326. A. Stage fright in musicians: A model illustrating the effect of beta-blockers.. Jr.. (1987). L. L. The American Organist (May). (1991). 88-08237) Journal of Personality and Social Psychology. Plott. 20. A. (1989).. Fingret. Plaut. E. In C. 4(2). 77-80.. Vagg. 191-205). Madsen. M. (1980).

D. Medical Problems of Performing Artists. 207-222). SYSTAT: The system for statistics. 4(1). No. Inc. L. Wine. IL: SYS- TAT. In H. Laux (Eds.). W. 64-67. (1990). stress. 1994 81 Weisblatt. Spring. 1(2). L. J. 49-56.Vol. Achievement. Wolfe. Correlates of adaptive and maladaptive musical performance anxiety. (1982). XXX/. 1. S. New York: Hemisphere Publishing Corporation. . (1986). Medical Problems of Performing Artists. and anxiety (pp. A psychoanalytic view of performance anxiety. A cognitive-attentional construct. M. Krohne & L. Evanston. Wilkinson. (1989).

5. notification letters will be mailed by June 1. 3.Journal ofMusic Therapy. 82 ©1994 by the NationalAsssociation for Music Therapy. 1994. The following guidelines will be in effect for the paper selection process: 1. letter-size envelope and a self-addressed. stamped postcard with the submission. speech. Call For Papers The American Orff-Schulwerk Association will sponsor research poster sessions at its 1994 national conference in Philadelphia. Research reports dealing with any aspect of music learning through movement. and the author(s) of each accepted paper will be expected to be present at the poster session in order to discuss the project with interested music educators. or composition in general music or music therapy settings would be particularly appropriate. The abstracts and reports will not be returned. Papers submitted for the conference must comply with the “Code of Ethics” published in each issue of the Journal of Research in Music Education. singing. 4. Submit five copies of the completed study of no more than 12 pages and five copies of a 250-word abstract to: Cecilia Wang School of Music University of Kentucky Lexington. Submission must be postmarked by April 1 and received by April 15. 1994. XXXI (1). 2. A poster presentation format will be utilized. Inc. KY 40506-0022 Include both a self-addressed. The author’s name and institutional affiliation should appear only on a separate Cover page. improvisation. stamped. 1994. . playing. 1994. as well as 10 copies of the complete report. November 9-13. PA. A qualified group of judges will screen the submitted reports. The author(s) will also be asked to furnish 100 copies of a report summary of two pages or less.

. 118 Fall 1993 Table of Contents Articles of Interest Teacher Knowledge in Music Education Research .. .For Your Information Bulletin of the Council for Research in Music Education No. . . . . . . .1 Eminence in Music Education ResearchasMeasured in the Handbook of Researchon Music Teachingand Learning . . and SharonParker . .Donald Speer. 21 Perception and Performance of Dynamics and Articulation Among Young Pianists . 33 .... . . . . . . . . . . . . . . . . .. .Liora Bresler .John Kratus . .Cornelia Yarbrough. . . . . . .

.RESEARCH PUBLICATION/PRESENTATION CODE OF ETHICS The following code has been approved by the National Research Committee of the National Association for Music Therapy and by the Executive Committee of the Music Education Research Council of the Music Educators National Conference.

An abstract of 150-200 words should accompany the manuscript. Five copies of the manuscript must be submitted and must conform with the most recent style requirements set forth in the PUBLICATIONS MANUAL for the American Psychological Association (APA). Center for Music Research. Manuscripts will be acknowledged upon receipt by the Editor and will not be returned.INFORMATION TO CONTRIBUTORS Manuscripts should be addressed to Editor. The Florida State University. Accepted articles will ordinarily appear in print within 12 months after acceptance. Authors are also requested to remove all identifying personal data from submitted articles. Florida 32306. Since manuscripts are sent out anonymously for editorial review. JOURNAL OF MUSIC THERAPY. . the author’s name and affiliations should appear only on a separate page. Chicago (Turabian) style is also acceptable. Contributors can usually expect a decision concerning the acceptability of a manuscript for publication within 2-3 months after receipt. For historical or philosophical papers. Tallahassee.

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